cefamandole and Peritonitis

Our data support the premise that antimicrobial therapy for peritonitis must be individualized. In the patient with minimal and moderate contamination who is not suppressed and who will undergo prompt and correct surgical therapy, then a single antimicrobial agent, such as cefamandole or perhaps even a first generation cephalosporin, such as cefazolin, will be adequate therapy even in instances of polymicrobial peritonitis when anticipated resistant organisms are present. In this situation, a single drug will be just as effective and safer when compared with the combination of an aminoglycoside and a specific antianaerobic agent. On the other hand, in the patient with immunosuppression, who is late to come to treatment or who has hospital acquired sepsis with probably a large contamination of resistant organisms, either a third generation cephalosporin with extended coverage or triple drug therapy, including a broad spectrum penicillin, an aminoglycoside and an anaerobic effective agent, should be the treatment of choice. Also, for infections with a culture proved overwhelming anaerobic flora, an antimicrobial specific for these pathogens should be used. The dictum, however, that all instances of peritonitis mandate double or triple drug therapy is a clinical impression based upon experimental models which do not correctly simulate the clinical situation.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefamandole; Clindamycin; Clinical Trials as Topic; Costs and Cost Analysis; Drug Resistance, Microbial; Drug Therapy, Combination; Female; Gentamicins; Humans; Kidney; Male; Middle Aged; Peritonitis; Prospective Studies; Subphrenic Abscess; Surgical Wound Infection

Cefamandole in combination with tobramycin was evaluated in the treatment of peritonitis as an adjunct to laparotomy and performance of the indicated surgical procedure in 88 patients. The clinical response was judged satisfactory in 91 per cent. Of four deaths, only one could be attributed to infection. Side effects noted were decreased creatinine clearance in 16 patients, increased liver enzymes in ten patients, and eosinophilia in nine patients. Microbiologic studies revealed aerobic peritonitis in 44 cultures and anaerobic in 32. Eighty-five per cent of the gram-negative and 69 per cent of the gram-positive strains were susceptible to cefamandole. Cefamandole alone or in combination with tobramycin appears to be an effective and safe antibiotic when used in appropriate doses for the treatment of bacterial peritonitis.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefamandole; Child; Clinical Trials as Topic; Drug Therapy, Combination; Female; Humans; Laparotomy; Male; Microbial Sensitivity Tests; Middle Aged; Peritonitis; Postoperative Complications; Risk; Tobramycin

A study of 130 adult patients with surgically treated gangrenous or perforated appendicitis was undertaken to evaluate the efficacy of three antibiotic regimens. Forty-eight patients received cefamandole, 40 were given the combination of clindamycin and gentamicin, and 42 were treated with cefoperazone. Side effects from these antibiotics were infrequent and mild. When all cases were compared for infectious failure, clindamycin-gentamicin showed a clear advantage over cefamandole. Because of the heterogeneity of the total study population, patients with perforation and peritonitis were compared separately. This analysis confirmed the advantage of clindamycin-gentamicin over cefamandole. In addition, it appears that clindamycin-gentamicin is more efficacious than cefoperazone.

Topics: Adolescent; Adult; Aged; Appendicitis; Cefamandole; Cefoperazone; Cephalosporins; Clindamycin; Clinical Trials as Topic; Double-Blind Method; Drug Therapy, Combination; Female; Gangrene; Gentamicins; Humans; Intestinal Perforation; Male; Middle Aged; Peritonitis; Random Allocation

Cefamandole, a new antibiotic with various characteristics was applied clinically in the field of obstetrics and gynecology, and following results were obtained. Cefamandole was administered to 8 cases with cystitis, 2 cases with pelvic infection. The organisms isolated were 5 cases of Escherichia coli, 4 cases of Staphylococcus epidermidis and one case of Klebsiella. Bacteria disappeared in all cases after 5-day treatment with cefamandole. No side effects of the drug were noticed throughout all cases. From the above mentioned clinical experience, cefamandole is considered to be a useful drug for clinical application.

Topics: Abscess; Acute Disease; Adolescent; Adult; Cefamandole; Cephalosporins; Clinical Trials as Topic; Cystitis; Female; Humans; Male; Middle Aged; Peritonitis; Vaginal Diseases

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Bacterial Infections; Cefamandole; Child; Child, Preschool; Clindamycin; Drug Therapy, Combination; Erythromycin; Female; Gentamicins; Humans; Infant; Male; Metronidazole; Middle Aged; Peritonitis; Surgical Wound Infection

Primary peritonitis (PP) is an infection of the peritoneal cavity occurring in the absence of a documented intraabdominal source of contamination. It is one of the main infectious complications of cirrhosis but is rare in healthy subjects. The purpose of this retrospective study is to describe a series of 15 cases of PP treated over a 3-year period at the Principal Hospital in Dakar, Senegal. The patient population was young (all but 2 under age of 13 years) and predominantly female (87%) with no predisposing factors. Clinical presentation always involved typical peritonitis. Surgical exploration was performed in all cases by laparotomy (n=13) or laparoscopy (n=2). Intra-operative bacteriologic sampling was performed systematically. Probabilistic antimicrobial therapy was administered in all cases using a triple-drug combination including a cephalosporin or betalactamine, an aminoside and metronidazole. This unconventional combination was designed to allow low-cost wide-spectrum coverage. As in patients with cirrhosis, the most common microbial agents were gram-negative bacteria (47%). Streptococcus pneumoniae was identified in 40% of cases. Infectious ORL and pulmonary sites were suspected in some cases. Although no supporting bacteriologic evidence was obtained, the high frequency of pneumococcal involvement as well as the age and female predominance of the patient population is consistent with contamination via the female genital tract. The cases in this series present unusual epidemiological, clinical and bacteriologic features. In Europe surgical treatment can be avoided thanks to the availability of modern facilities to support further laboratory examinations. In Africa antimicrobial therapy and peritoneal lavage are the mainstay treatments. Use of laparoscopy should be expanded.

Topics: Adolescent; Adult; Africa South of the Sahara; Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Anti-Bacterial Agents; Cefamandole; Child; Child, Preschool; Drug Combinations; Female; Gentamicins; Humans; Laparoscopy; Male; Metronidazole; Middle Aged; Peritonitis; Retrospective Studies

The treatment of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) usually includes the repeated administration of intraperitoneal (ip) antibiotics. The initial segment of this study (15 noninfected CAPD patients) examined the ip administration of four structurally different agents that represent the common types of antibiotics prescribed for peritonitis: an aminoglycoside (tobramycin), a glycopeptide (vancomycin), a beta-lactam (cefamandole), and an oxa-beta-lactam (moxalactam). Subsequently, 16 CAPD patients with peritonitis received either vancomycin (30 mg/kg) or cefamandole (1 g) in two liters of dialysate over a six-hour dwell period. Vancomycin and cefamandole were absorbed more rapidly in patients with peritonitis as indicated by a more rapid decline in dialysate concentrations, and higher serum concentrations that occurred earlier than in the noninfected patients. Although a higher percentage of the ip dose of vancomycin and cefamandole was absorbed during peritonitis, peak serum concentrations at the end of the drug administration dwell period were not significantly different. Numerous factors influence the absorption of ip antibiotics, including the dialysate drug concentration, the dwell period, protein binding, distribution volume, and presence or absence of peritonitis.

Topics: Absorption; Anti-Bacterial Agents; Cefamandole; Humans; Infusions, Parenteral; Kidney Failure, Chronic; Moxalactam; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Radioimmunoassay; Tobramycin; Vancomycin

The pharmacokinetic characteristics of cefonicid, a highly protein-bound expanded-spectrum cephalosporin, were examined in six noninfected, clinically stable patients undergoing continuous ambulatory peritoneal dialysis. After a 1.0-g intravenous dose of cefonicid, the mean concentrations in serum were 105 +/- 25 and 35.6 +/- 14.4 micrograms/ml at 3 and 72 h, respectively. Despite a prolonged half-life in serum of 49.7 +/- 18 h, the penetration into peritoneal fluid was low. The average concentration in dialysate over the 72-h study period was 2.7 micrograms/ml. The serum clearance was 2.6 +/- 1.0 ml/min, and the distribution volume was 0.14 +/- 0.02 liter/kg. Dosage recommendations and clinical considerations for cefonicid use in continuous ambulatory peritoneal dialysis patients are discussed.

Topics: Cefamandole; Cefonicid; Humans; Kidney Failure, Chronic; Kinetics; Peritoneal Cavity; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis

Topics: Adult; Aged; Bacterial Infections; Cefamandole; Cross Infection; Female; Humans; Male; Middle Aged; Peritoneal Dialysis; Peritonitis

An investigation was carried out into the effectiveness of cefamandole as compared to that of cephalothin against methicillin-sensitive and methicillin-resistant strains of Staphylococcus aureus both in vitro and in mice with the experimental peritonitis-induced septicaemia as a model for a generalized infection. In the agar-diffusion test 95% of 118 and in the broth-dilution test 80% of 30 methicillin-resistant strains were sensitive to cefamandole. In experimental infections the ED50 with methicillin-resistant strains was 20 times greater than that required for the methicillin-sensitive strain although the MIC was only twice that for the latter. Doses of cephalothin required for treatment of infections due to methicillin-resistant strains were also twenty times greater than for those due to the methicillin-sensitive strain. But these differences were consistent with those in MIC (by factors of 16-32). Thus, the results of in-vitro testing of cefamandole are not predictive for its therapeutic efficacy in staphylococcal infections with methicillin-resistant strains. Therefore, rather than relying on inhibition zone diameter and MIC, the information that a staphylococcal strain is methicillin-resistant should be used as an indication not to choose cefamandole for chemotherapy.

Topics: Animals; Cefamandole; Male; Methicillin; Mice; Microbial Sensitivity Tests; Oxacillin; Penicillin Resistance; Peritonitis; Staphylococcal Infections; Staphylococcus aureus

The enthusiasm for the use of peritoneal irrigation has waxed and waned since its introduction by Dr. Pierce in 1905. The purpose of this study was to devise a relatively low-cost irrigant that could be used for continuous intraperitoneal lavage, with the intent of decreasing abscess formation following surgical treatment for generalized bacterial peritonitis. A solution of 1 L of normal saline containing 50 mg erythromycin, 50 mg cefamandole, 500 U heparin, and 5 mEq KCl was proven in in vitro studies to be bactericidal to Peptococcus anaerobius and Clostridium perfringens, and bacteriostatic to Klebsiella pneumoniae, Escherichia coli, Enterobacter aerogenes, Streptococcus faecalis, and Bacteroides fragilis. In a prospective study 50 patients underwent peritoneal lavage with 36 L over 2 days. No lavage patients developed intraabdominal abscesses. In a control group of 44 patients seven patients (15.9%) developed postoperative abscesses.

Topics: Adult; Bacterial Infections; Cefamandole; Drug Combinations; Erythromycin; Heparin; Humans; In Vitro Techniques; Middle Aged; Peritonitis; Postoperative Complications; Prospective Studies; Therapeutic Irrigation

Topics: Bacteria; Cefamandole; Cefoxitin; Child; Humans; Peritonitis; Suppuration

Cefamandole nafate is a derivative of 7-aminocephalosporanic acid which has been shown to have good in vitro activity against aerobes traditionally susceptible to cephalosporins as well as many anaerobes, including B. fragilis. One hundred women with obstetric or gynecologic infections completed treatment with cefamandole: 53 had post-cesarean section infections: 24, acute pelvic inflammatory disease: 16, posthysterectomy cuff cellulitis/abscess; and seven, vulvar or abdominal wound abscess. Almost 90% of these women had either polymicrobial aerobic/anaerobic bacterial infections or an anaerobic infection alone. Ninety women responded to cefamandole alone; in 10 cases chloramphenicol was added, but in addition five of these women required surgical therapy for eradication of infection. Mild to severe phlebitis at the infusion site that responded to conservative therapy was demonstrated in 14 women. Of 312 bacterial isolates from these women, 89% were sensitive to cefamandole at 32 microgram/ml, an easily achievable serum level; 93% of anaerobic streptococci, the most common isolates, were sensitive at 32 microgram/ml. Also, 90% of all Bacteroides species were susceptible at 32 microgram/ml; 82% of B. fragilis were susceptible at this concentration. These data indicate that cefamandole is safe and effective for treatment of women with polymicrobial pelvic infections but that approximately 5% of these women will require surgical exploration in addition to antimicrobial administration.

Topics: Abscess; Acute Disease; Bacterial Infections; Bacteroides Infections; Cefamandole; Cellulitis; Cephalosporins; Cesarean Section; Clostridium Infections; Endometritis; Enterobacteriaceae Infections; Female; Genital Diseases, Female; Humans; Hysterectomy; Peptococcus; Peptostreptococcus; Peritonitis; Pregnancy; Streptococcal Infections; Surgical Wound Infection; Vulvitis

Cefamandole was evaluated as the sole antimicrobial agent used to treat bacterial peritonitis in 113 patients. Dosage varied between 1 and 2 g given intravenously every 6 hr. Laparotomy for excision of infected or gangrenous tissues, closure of gastrointestinal perforations, or drainage of an established abscess was required in 99 of the cases. A good clinical response was obtained in 107 patients, or 95% of the total group. Of the six deaths only one could be attributed to infection. No evidence of renal, hepatic, or hematopoietic toxicity was noted. There were no allergic reactions, although 13 patients (12%) developed phlebitis in a vein used for antibiotic administration. Bacteriological studies revealed aerobic peritonitis in 99% of the patients, with anaerobe participation in 60% of these cases. Sensitivity testing by the disk diffusion and tube dilution methods confirmed the appropriateness of cefamandole therapy; 91% of the gram-negative rods and 61% of the anaerobes were susceptible. From results of this study, it would appear that cefamandole is a reliably effective antibiotic for use in treatment of most forms of acute peritonitis. Its role in surgical prophylaxis may be even more promising.

Topics: Adult; Aged; Bacterial Infections; Bacteroides Infections; Cefamandole; Cephalosporins; Child, Preschool; Drug Resistance, Microbial; Enterobacteriaceae Infections; Female; Humans; Male; Peritonitis; Staphylococcal Infections