cefamandole and Osteomyelitis

Topics: Cefamandole; Cefonicid; Clinical Trials as Topic; Humans; Osteomyelitis; Outpatients

The safety and efficacy of treatment with cefamandole were evaluated in 77 patients (from 33 institutions) with serious bone and joint infections. The antibiotic was given intramuscularly or intravenously in doses ranging from 1.5 to 12 g/day for 6 to 58 days. Seventy-three of the 77 patients responded satisfactorily, and 63 (of 70 from whom material for culture was obtainable) patients had a bacteriologic cure. Forty-one of 81 isolates were identified as Staphylococcus aureus. Other pathogens included Streptococcus epidermidis, Haemophilus influenzae, Enterobacter sp., Escherichia coli, aerobic and anaerobic cocci, as well as Bacteroides fragilis. The drug was well tolerated. Pharmacological studies indicated that cefamandole penetrated the bones and joints. Cefamandole would seem to be a safe and efficacious drug, for the treatment of serious bone and joint infections due to a wide variety of gram-positive and gram-negative microorganisms.

Topics: Acute Disease; Bacteria; Bacterial Infections; Bone Diseases; Bursitis; Cefamandole; Cephalosporins; Chronic Disease; Clinical Trials as Topic; Female; Humans; Joint Diseases; Male; Middle Aged; Osteomyelitis

The epidemiology of acute paediatric osteoarticular infections (OAI) has recently evolved, mainly due to the improvement of microbiological diagnosis. We conducted a prospective study to analyse the recent epidemiology and the clinical evolution of paediatric OAI in order to validate the adequacy of our probabilistic first-line antibiotic treatment (intraveinous cefamandole + gentamicin). All children suspected of community acquired OAI were included and followed-up for 3 years. The etiologic diagnosis was based on blood cultures, joint aspirations and bone punctures. All osteoarticular (OA) samples were systematically inoculated into blood culture bottles. Real-time universal 16S rRNA and PCR targeted on Staphylococcus aureus, Kingella kingae, Streptococcus pneumoniae and Streptococcus pyogenes were performed twice a week. From 17 March 2007 to 26 February 2009, 98 septic arthritis, 70 osteomyelitis, 23 osteoarthritis and six spondylodiscitis were analysed. A portal of entry was suspected in 44% of cases, including 55% of otorhinolaryngological infections. C reactive protein was the most sensitive inflammatory marker. PCR increased by 54% the performance of bacteriological diagnosis. Among the patients completely investigated (blood culture and OAI samples), there were 63% documented OAI. The main pathogens found were K. kingae (52%), S. aureus (28%), S. pyogenes (7%), S. pneumoniae (3%) and Streptococcus agalactiae (2%). All isolated bacteria were sensitive to the probabilist treatment and outcome was favorable. PCR has significantly improved the performance and the delay of IOA diagnosis in children, for which K. kingae turned out to be the first causative agent. The probabilistic treatment was active against the main bacteria responsible for paediatric OAI.

Topics: Adolescent; Anti-Bacterial Agents; Arthritis, Infectious; Cefamandole; Child; Child, Preschool; Discitis; Drug Therapy, Combination; Female; Gentamicins; Humans; Infant; Infant, Newborn; Kingella kingae; Male; Osteoarthritis; Osteomyelitis; Polymerase Chain Reaction; Prospective Studies; Staphylococcus aureus; Streptococcus; Streptococcus agalactiae; Streptococcus pneumoniae; Streptococcus pyogenes

The pathophysiologic mechanism of acute hematogenous osteomyelitis in children has been further elucidated. Investigations revealed, that certain strains of staphylococcus aureus, responsible for the majority of infections, can resist intracellular killing after phagocytosis. Beta-lactam-antibiotics don't penetrate well into phagocytes and are unable to eradicate staphylococci surviving intracellularly. Fosfomycin, clindamycin and combinations of these antibiotics with beta-lactam-antibiotics are able to eradicate staphylococci also in phagocytic vacuoles. In a therapeutic investigation 36 patients have been treated with fosfomycin in combination with cefamandole intravenously for 10-14 days followed by clindamycin orally for 3-6 weeks. With this treatment schedule the therapeutic outcome was superior to previously employed therapeutic regimen.

Topics: Cefamandole; Child; Clindamycin; Drug Therapy, Combination; Fosfomycin; Humans; Macrophages; Osteomyelitis; Oxacillin; Phagocytosis; Sepsis; Staphylococcal Infections; Staphylococcus aureus

Selected patients with community-acquired infections can be discharged from the hospital, when afebrile and stable, with parenteral antibiotic therapy continued on an ambulatory basis. This therapy is currently possible because of the availability of long-acting cephalosporins that can be administered once daily, often with substantial reductions in hospital costs. Cefonicid and ceftriaxone both have sufficiently long half-lives and either may be administered intramuscularly once daily. Their antibacterial spectra encompass many of the pathogens encountered in community-acquired infections of the lower respiratory tract, skin and soft tissue, bone, and urinary tract. Ceftriaxone, a third-generation cephalosporin, has a broader spectrum than the second-generation agent cefonicid. Ceftriaxone should generally be reserved for the treatment of gonococcal disease and of community- or hospital-acquired infections due to organisms resistant to the narrower-spectrum and less expensive long half-life agent cefonicid.

Topics: Ambulatory Care; Cefamandole; Cefonicid; Ceftriaxone; Costs and Cost Analysis; Humans; Osteomyelitis; Pneumonia; Pyelonephritis; Skin Diseases, Infectious

Cefonicid (Monocid) and ceftriaxone (Rocephin) are long half-life cephalosporins that may be used for serious infections in the outpatient setting. They may be used as an extension of initial hospital treatment, or therapy can be initiated and completed in many cases with the patient remaining at home. Sufficient clinical experience exists with both ceftriaxone and cefonicid to recommend these agents for selected patients having pyelonephritis, osteomyelitis, or soft tissue infections. Cefonicid, perhaps in combination with erythromycin, will provide excellent coverage for complicated community-acquired pneumonias. Ceftriaxone is effective as single-dose therapy for even complicated gonococcal infections. The use of long half-life cephalosporins in ambulatory practice may result in substantial cost savings for certain patients.

Topics: Ambulatory Care; Bacterial Infections; Cefamandole; Cefonicid; Ceftriaxone; Cellulitis; Cephalosporins; Gonorrhea; Half-Life; Humans; Injections, Intramuscular; Osteomyelitis; Pyelonephritis; Respiratory Tract Infections; Staphylococcal Infections; Streptococcal Infections

Hemophilus aphrophilus is an uncommon pathogen in man. It has rarely been reported as a cause of meningitis, exclusively in boys three years or younger. Osteomyelitis due to this organism is also rare. H. aphrophilus was responsible for meningitis, probable thoracic empyema, and ultimately vertebral osteomyelitis and suppurative psoas abscess formation in a woman following metrizamide myelography. The patient responded well to antibiotic treatment and surgical drainage. The organism was sensitive not only to chloramphenicol but also to newer cephalosporin antibiotics.

Topics: Abscess; Aged; Ampicillin; Cefamandole; Child, Preschool; Chloramphenicol; Female; Humans; Infant; Lumbar Vertebrae; Male; Meningitis, Haemophilus; Osteomyelitis; Tomography, X-Ray Computed

Seven patients with chronic osteomyelitis were treated by surgical debridement. Cefamandole was administered intravenously before surgery. During the debridement, cefamandole concentrations were measured in serum and necrotic bone. Although adequate levels of antibiotic were achieved in the serum, minimal or no concentration of antibiotic was found in the necrotic bone. There was only minimal penetration of cefamandole into necrotic bone.

Topics: Bone and Bones; Cefamandole; Humans; Humerus; Metatarsus; Osteomyelitis; Tibia; Ulna

Osteomyelitis of the pubic bone due to anaerobic bacteria has been reported infrequently, although an entity known as "sterile" osteitis pubis is common to the literature. We have described two cases of pubic osteomyelitis due to anaerobic bacteria, discussed two previously reported cases, and suggested that most cases of what has previously been termed sterile osteitis pubis may actually have been due to anaerobic bacteria that were not isolated because of deficiencies in collection, transport, and culture of clinical specimens. Included are the pathogenesis and an approach to the treatment of this entity.

Topics: Abscess; Adult; Aged; Bacteria, Anaerobic; Bacterial Infections; Bone Marrow; Carcinoma, Squamous Cell; Cefamandole; Clindamycin; Female; Humans; Osteomyelitis; Pubic Bone; Vulvar Neoplasms

Cefamandole was evaluated for the initial management of bacterial infections in 60 infants and children. Infections included cellulitis (22), pneumonia (21), cervical lymphadenitis (8), arthritis or osteomyelitis (6), otitis media (2), and epiglottitis 91). Appropriate bacterial cultures and laboratory tests were performed for all patients. Cefamandole, 100 to 150 mg/kg/day divided into four doses given every six hours, was administered by the intravenous route. All bacterial isolates were sensitive to cefamandole, and all patients had good clinical and bacteriological responses. Duration of cefamandole therapy ranged between three and 30 days. Some of the patients' treatments were changed to specific narrow-spectrum antimicrobials after availability of the bacterial sensitivities. Cefamandole was tolerated well by most patients. Mild leukopenia and neutropenia developed in one patient and slight eosinophilia in four patients. These hematological abnormalities resolved spontaneously. These data suggest that cefamandole is an effective agent for the initial treatment of nonmeningitic infections in children.

Topics: Adolescent; Arthritis, Infectious; Bacterial Infections; Cefamandole; Cellulitis; Child; Child, Preschool; Epiglottitis; Female; Humans; Infant; Lymphadenitis; Male; Osteomyelitis; Otitis Media; Pneumonia

Topics: Animals; Cefamandole; Cephalosporins; Cephalothin; Microbial Sensitivity Tests; Osteomyelitis; Rabbits; Staphylococcal Infections; Staphylococcus aureus

Seventy-five infants and children with suppurative skeletal infections were managed with a sequential parenteral-oral regimen of cephalosporin antibiotic therapy. Initially, parenteral antibiotics (cefamandole for 48 patients and cefuroxime for 27 patients) were given for a median of 5 days. Oral therapy was with large doses of cefaclor (150 mg/kg/day) or cephalexin (100 mg/kg/day). Eight patients (11%) had inadequate serum bactericidal activity with cefaclor. Six of them were successfully managed with alternative oral antibiotics, and parenteral therapy resumed in one patient. Chronic disease developed in a child who was continued on oral cloxacillin therapy in spite of absent serum bactericidal activity. It is concluded that oral therapy can be successful for the majority of patients but that it is hazardous and not indicated if careful laboratory monitoring of compliance and serum bactericidal activity cannot be performed.

Topics: Acute Disease; Administration, Oral; Arthritis, Infectious; Bacterial Infections; Cefaclor; Cefamandole; Cefuroxime; Cephalexin; Cephalosporins; Child; Child, Preschool; Drug Therapy, Combination; Female; Humans; Infant; Infusions, Parenteral; Male; Osteoarthritis; Osteomyelitis; Suppuration

We used cefamandole in the initial treatment of 34 children (10 months to 15 years of age) with suspected bone, joint, or soft tissue infections. The minimal inhibitory concentration of organisms encountered ranged between 0.015 and 2 microgram/ml. At 1 h after intravenous infusion of 25 mg/kg, the mean serum level of cefamandole was 26.2 microgram/ml (range, 8.9 to 47.5 microgram/ml), and at 3 h the level was 1.8 microgram/ml (range, 0.6 to 4.4 microgram/ml), which is above the minimal inhibitory concentration for most of the organisms encountered. However, when the drug was given intravenously every 6 h, the mean level after a 37-mg/kg dose was 0.9 microgram/ml (range, less than 0.5 to 1.9 microgram/ml) at 4 h and, by extrapolation, would have fallen below 0.1 microgram/ml at 6 h. The mean serum half-life was 34 min. Cefamandole appeared to diffuse well into synovial fluid, with joint fluid levels between 5 and 40 microgram/ml. The drug was tolerated well. Cefamandole appears to be a reasonable alternative in the initial treatment of skeletal infections in children, but need to be administered every 4 h to maintain suprainhibitory serum levels between doses.

Topics: Adolescent; Arthritis, Infectious; Bacterial Infections; Cefamandole; Cellulitis; Cephalosporins; Child; Child, Preschool; Half-Life; Humans; Infant; Osteomyelitis; Wound Infection

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

In review of our data, 12 of 38 patients (31.5 percent) had adverse drug reactions, a somewhat bothersome factor. Disturbing side effects of leukopenia and pancytopenia were seen in two patients, respectively, who were receiving cefamandole 12 g/d. Other cephalosporins, including cephalothin and cefazolin, have been reported to cause leukopenia. Eosinophilia and elevations of alkaline phosphatase and SGOT levels were noted with other cephalosporins. We observed no adverse clinical reactions associated with these findings. Although our study was able to demonstrate the therapeutic effectiveness of cefamandole in the treatment of soft tissue and skeletal infections, it should be reemphasized that cefamandole should be used only as an alternative treatment for the penicillin-allergic patient. In reality, a first-generation cephalosporin should be used for gram-positive organisms if one is required in soft tissue infections.

Topics: Abscess; Adolescent; Adult; Aged; Arthritis, Infectious; Bacterial Infections; Bone Diseases; Cefamandole; Cellulitis; Cephalosporins; Female; Half-Life; Humans; Joint Diseases; Male; Middle Aged; Osteomyelitis

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