cefamandole and Pneumonia--Bacterial

Our objective was to compare therapeutic outcome and analyse cost-benefit of a 'conventional' (7-day course of i.v. antibiotic therapy) vs. an abbreviated (2-day i.v. antibiotic course followed by 'switch' to oral antibiotics) therapy for in-patients with community-acquired pneumonia (CAP). We used a multicenter prospective, randomized, parallel group with a 28 day follow-up, at the University-based teaching hospitals: The Medical Center of Louisiana in New Orleans, LA and hospitals listed in the acknowledgement. Ninety-five patients were randomized to receive either a 'conventional' course of intravenous antibiotic therapy with cefamandole 1 g i.v. every 6 h for 7 days (n = 37), or an abbreviated course of intravenous therapy with cefamandole (1 g i.v. every 6 h for 2 days) followed by oral therapy with cefaclor (500 mg every 8 h for 5 days). No difference was found in the clinical courses, cure rates, survival or the resolution of the chest radiograph abnormalities among the two groups. The mean duration of therapy (6.88 days for the conventional group compared to 7-30 days for the early oral therapy group) and the frequencies of overall symptomatic improvement (97% vs. 95%, respectively) were similar in both groups. Patients who received early oral therapy had shorter hospital stays (7.3 vs. 9.71 days, P = 0.01), and a lower total cost of care ($2953 vs. $5002, P < 0.05). It was concluded that early transition to an oral antibiotic after an abbreviated course of intravenous therapy in CAP is substantially less expensive and has comparable efficacy to conventional intravenous therapy. Altering physicians' customary management of hospitalized patients with CAP can reduce costs with no appreciable additional risk of adverse patient outcome.

Topics: Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Cefaclor; Cefamandole; Cephalosporins; Community-Acquired Infections; Female; Health Care Costs; Hospitalization; Humans; Injections, Intravenous; Length of Stay; Male; Middle Aged; Pneumonia, Bacterial; Prospective Studies; Treatment Outcome

The recommended antibiotic prophylaxis by second-generation cephalosporins reduces the incidence of wound infection and empyema, but its effectiveness on postoperative pneumonias (POPs) after major lung resection lacks demonstration. We investigated risk factors and characteristics of POPs occurring when antibiotic prophylaxis by second-generation cephalosporin or an alternative prophylaxis targeting organisms responsible for bronchial colonization was used.. An 18-month prospective study on all patients undergoing lung resections for noninfectious disease was performed. Prophylaxis by cefamandole (3 g/24 h, over 48 hours) was used during the first 6 months, whereas amoxicillin-clavulanate (6 g/24 h, over 24 hours) was used during the subsequent 12 months. Intraoperative bronchial aspirates were systematically cultured. Patients with suspicion of pneumonia underwent bronchoscopic sampling for culture.. Included were 168 patients in the first period and 277 patients in the second period. The incidence of POP decreased by 45% during the second period (P = 0.0027). A significant reduction in antibiotic therapy requirement for postoperative infections (P = 0.0044) was also observed. Thirty-day mortality decreased from 6.5% to 2.9% (P = 0.06). Multivariate analysis showed that type of resection, intraoperative colonization, chronic obstructive pulmonary disease, gender, body mass index, and type of prophylaxis were independent risk factors of POP. A case control-study that matched patients of the two periods according to these risk factors (except for antibiotic prophylaxis) confirmed that the incidence of POP was lowered during the second period.. Targeted antibiotic prophylaxis may decrease the rate of POPs after lung resection and improve outcome.

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Antibiotic Prophylaxis; Bronchitis; Case-Control Studies; Cefamandole; Cephalosporins; Dose-Response Relationship, Drug; Drug Administration Schedule; Education, Medical, Continuing; Female; Follow-Up Studies; France; Humans; Incidence; Lung Diseases; Male; Middle Aged; Multivariate Analysis; Pneumonectomy; Pneumonia, Bacterial; Postoperative Complications; Preoperative Care; Probability; Prospective Studies; Reference Values; Risk Assessment; Surgical Wound Infection; Survival Rate

Topics: Aged; Aged, 80 and over; Antibiotic Prophylaxis; Aortic Aneurysm, Abdominal; Bacteremia; Cefamandole; Cephalosporin Resistance; Cephalosporins; Drug Resistance, Multiple; Enterobacter cloacae; Enterobacteriaceae Infections; Humans; Male; Pneumonia, Bacterial; Postoperative Complications