cefamandole and Pneumonia

In a patient with pneumonia, sputum culture revealed ampicillin-resistant Haemophilus influenzae, type b. Although nontypable H influenzae is a normal inhabitant of the upper respiratory tract and should be considered normal flora, typable H influenzae is found in less than 5% of healthy persons. Although only 1.8% of sputum cultures reveal typable H influenzae, these strains account for 98.3% of isolates from blood cultures of patients with pneumonia due to H influenzae. Serotyping of sputum isolates is recommended in patients with pneumonia to separate pathogenic typable strains from nonpathogenic nontypable strains.

Topics: Cefamandole; Child; Haemophilus Infections; Haemophilus influenzae; Humans; Male; Penicillin Resistance; Pneumonia; Serotyping; Sputum

In a randomized prospective study ampicillin/sulbactam and cefamandole were compared in the therapy of patients hospitalized with community acquired pneumonia. Patients receiving ampicillin/sulbactam (n = 37) and cefamandole (n = 38) were similar with respect to age (mean age 70 vs. 76 years respectively), clinical characteristics, severity of illness and underlying disease. Pathogens isolated from patients in the cefamandole and ampicillin/sulbactam group, respectively, were Streptococcus pneumoniae (7 vs. 7 patients), Haemophilus parainfluenzae (7 vs. 6 patients), Haemophilus influenzae (5 vs. 5 patients), Staphylococcus aureus (5 vs. 4 patients), Escherichia coli (4 vs. 4 patients), Klebsiella pneumoniae (3 vs. 3 patients), Enterobacter spp. (2 vs. 3 patients), Moraxella catarrhalis (1 vs. 2 patients), and organisms of the oral flora (4 vs. 3 patients). The rate of resistance to penicillin was 80%, to clindamycin 76%, to erythromycin 45%, to ampicillin 43%, and to cefazolin 18%. Overall successful treatment rates of 81% for cefamandole and 97% for ampicillin/sulbactam (p = 0.05) were observed. Both cefamandole and ampicillin/sulbactam were shown to be effective agents for therapy of community acquired pneumonia; however ampicillin/sulbactam demonstrated superior overall clinical efficacy.

Topics: Adult; Aged; Aged, 80 and over; Ampicillin; Bacteria; Bacterial Infections; Cefamandole; Community-Acquired Infections; Female; Humans; Male; Middle Aged; Pneumonia; Prospective Studies; Sputum; Sulbactam

Infections of the lower respiratory tract pose an important problem in nursing homes. Despite the magnitude of this problem, few, if any, antibiotic studies have been targeted specifically at nursing home-acquired bronchopulmonary infections. Following the establishment of a teaching Extended-Care Nursing Home Program, which facilitated the early diagnosis and therapy of bronchopulmonary infections, a comparative trial of oral ciprofloxacin and intramuscular cefamandole was initiated in elderly patients with lower respiratory tract infections. In addition to assessing the relative efficacy and safety of ciprofloxacin and cefamandole, our goals were to identify problems and pitfalls associated with conducting clinical research in this nursing home setting, evaluate selected clinical and laboratory features of lower respiratory tract infection in this patient population, and measure outcomes in all study groups.. During a 20-month period, 40 patients with pneumonia and 20 patients with acute bronchitis were enrolled in this randomized study. Sixty-three patients with pneumonia who were ineligible for the randomized study were also followed prospectively. The mean age of the 111 participants (123 cases) was 80.8 years; all patients had at least one chronic medical condition.. Although Streptococcus pneumoniae was the single most common isolate, gram-negative bacteria were cultured from 81 percent of the cases that yielded pathogens from a satisfactory sputum specimen. The in-hospital mortality rate was strikingly low (6.5 percent), and a large majority of patients in all study groups were discharged safely back to their nursing homes well within the Diagnosis-Related Group length of stay.. Ciprofloxacin appeared to be as safe and effective as cefamandole in this nursing home program; however, additional studies are needed to determine its role in the treatment of elderly patients with bronchopulmonary infections.

Topics: Administration, Oral; Aged; Aged, 80 and over; Bronchitis; Cefamandole; Ciprofloxacin; Clinical Trials as Topic; Female; Humans; Male; Middle Aged; Nursing Homes; Pneumonia; Prospective Studies; Random Allocation; Respiratory Tract Infections

One hundred seven patients with community-acquired pneumonia thought to be of bacterial etiology by the admitting physician but whose initial sputum Gram stain was inadequate to direct specific therapy were randomized to receive either intravenous ampicillin or cefamandole as empiric therapy. Patients were excluded if the initial sputum Gram stain was highly suggestive of infection with Streptococcus pneumoniae, Staphylococcus aureus, or an enteric gram-negative bacillus. The two study groups had comparable demographic and presenting clinical features. The mean age of the patients evaluable for determination of clinical efficacy was 69 years, and greater than 75% had at least one serious underlying medical disorder. In the 90 evaluable patients, there were 11 therapeutic failures (12%), including 5 deaths (5%). Cefamandole, a broad-spectrum antibiotic, was not more efficacious than ampicillin in producing a satisfactory clinical response or in shortening the duration of parenteral therapy. Patients received an average of only 4 days of intravenous antibiotics before changeover to oral therapy and were hospitalized for a mean of 7 days. No patient experienced a relapse of pneumonia following successful completion of parenteral drug therapy. We conclude that cefamandole is not a more effective agent than ampicillin for empiric therapy of community-acquired bacterial pneumonia of uncertain etiology.

Topics: Administration, Oral; Aged; Ampicillin; Cefamandole; Clinical Trials as Topic; Double-Blind Method; Female; Humans; Injections, Intravenous; Male; Middle Aged; Pneumonia

Ceftazidime and cefamandole were compared in a randomized multicentre trial in hospitalized patients with pneumonia. Of 290 patients enrolled, 92 patients in the ceftazidime group and 71 patients in the cefamandole group were evaluable. Geometric mean MICs of organisms isolated and tested to ceftazidime were within achievable therapeutic serum concentrations of ceftazidime. Satisfactory clinical responses were observed in 91% (84/92) of ceftazidime-treated patients and 83% (59/71) of cefamandole-treated patients (P greater than 0.05). Superinfection occurred in one (1%) ceftazidime-treated patient and in five (7%) cefamandole-treated patients. Side effects were infrequent with either treatment. Ceftazidime is as safe and effective as cefamandole for the treatment of pneumonia due to a variety of Gram-positive and Gram-negative pathogens.

Topics: Adult; Aged; Bacteria; Cefamandole; Ceftazidime; Humans; Microbial Sensitivity Tests; Middle Aged; Pneumonia

Patients with pneumonia or bronchitis were randomized to receive ceftriaxone or cefamandole. A total of 30 of 38 patients were evaluable, 16 in the ceftriaxone group (average age 66.3 years) and 14 in the cefamandole group (average age 69.4 years). All but one had underlying diseases. Patients usually received 1 g of ceftriaxone intravenously every 12 h (mean duration 8.7 days) or 1.5 g of cefamandole intravenously every 6 h (mean duration 8.2 days). Adverse experiences attributable to the drugs were confined to one episode of discomfort at the infusion site in each group. Bacteriological results with ceftriaxone were 83% cured, 11% superinfected after eradication of pretherapy isolate, and 6% failed. Bacteriological results with cefamandole were 76% cured, 24% failed. Clinical results with ceftriaxone were 38% cured, 56% improved, 6% failed. Clinical results with cefamandole were 57% cured, 21% improved, 21% failed. Emergence of a resistant Serratia marcescens was seen in a ceftriaxone-treated patient. Disc diffusion susceptibility testing identified six of the seven pretherapy nonfastidious Gram-negative isolates as susceptible; however, two of the six could not be eradicated with the assigned drug and another two were eradicated with ensuing super-infection with susceptible isolates of Pseudomonas aeruginosa. In contrast, MBCs were an accurate guide to clinical outcome with nonfastidious Gram-negative bacilli.

Topics: Adult; Aged; Aged, 80 and over; Bronchitis; Cefamandole; Ceftriaxone; Female; Humans; Male; Middle Aged; Pneumonia; Random Allocation; Sepsis

Fifty-nine community-acquired pneumonias were treated in a randomized double blind trial with cefamandole or ceftazidime. A prospective scoring system was used to define severity. This made use of basic clinical data, associated diseases, white blood count, blood gases and chest radiographs. There were no serious side-effects from the drugs. There were two deaths and six failed treatment. The scoring system which defined an 'ill group' showed as good a response of these ill patients to the new cephalosporin, ceftazidime as to cefamandole.

Topics: Adult; Cefamandole; Ceftazidime; Cephalosporins; Clinical Trials as Topic; Double-Blind Method; Female; Fever; Humans; Injections, Intravenous; Male; Middle Aged; Phlebitis; Pneumonia; Random Allocation

Topics: Adult; Aged; Bronchitis; Cefamandole; Cefotaxime; Ceftizoxime; Cephalosporins; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Pneumonia

Topics: Adolescent; Adult; Aged; Body Temperature; Cefamandole; Cefotaxime; Ceftizoxime; Cephalosporins; Child, Preschool; Female; Humans; Leukocyte Count; Male; Middle Aged; Pneumonia; Radiography

Topics: Adult; Aged; Cefamandole; Cefotaxime; Ceftizoxime; Cephalosporins; Female; Hospitalization; Humans; Male; Middle Aged; Pneumonia; Pyelonephritis; Random Allocation; Sepsis; Urinary Tract Infections

Cefonicid (Smith Kline & French Laboratories; D-75073) is a new parenteral cephalosporin with a markedly long half-life, high serum levels, and good in vitro activity against Haemophilus influenzae. Patients with community-acquired pneumonia were randomized 2:1 to receive cefonicid, 1 g daily (21 cases) or cefamandole, 1 g every 6 h (12 cases). The two groups were similar, except that the cefonicid patients were older (mean 42 versus 31 years). Peak serum levels of cefonicid averaged 133 microgram/ml after intravenous and 83 microgram/ml after intramuscular administration compared with 55 microgram/ml with intravenous cefamandole. All 9 patients on intramuscular cefonicid and 8 or 12 patients on intravenous cefonicid had trough serum levels of greater than 2.0 microgram/ml at 24 h. Sputum levels of cefonicid were usually between 2.0 and 4.0 microgram/ml and did not correlate with serum levels. Cefonicid was well tolerated, and all cefonicid patients responded clinically. Sputum cultures for H. influenzae or Streptococcus pneumoniae became negative in 6 of 7 cefamandole patients and 13 or 15 cefonicid patients. In in vitro studies, cefonicid inhibited 90% of beta-lactamase-negative h. influenzae at 0.5 microgram/ml and beta-lactamase-positive strains at 2.0 microgram/ml. Cefonicid inhibited 50% of S. pneumoniae at 1.6 microgram/ml, but required 6.4 microgram/ml to inhibit 90%. Cefonicid once a day appears to be as safe and as effective as cefamandole four times a day for therapy of community-acquired pneumonia.

Topics: Adult; Cefamandole; Cefonicid; Cephalosporins; Clinical Trials as Topic; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Male; Middle Aged; Pneumococcal Infections; Pneumonia; Random Allocation

Ceforanide is a new (parenteral) long-acting cephalosporin with antimicrobial activity comparable to those of other second-generation cephalosporins. In a randomized prospective study, patients with community-acquired bacterial pneumonia were treated with ceforanide at 0.5 g every 12 h (28 cases) or with cefazolin at 1.0 g every 8 h (26 cases). The study groups were comparable in clinical and laboratory findings, including etiological diagnosis. Streptococcus pneumoniae was isolated from the sputum of 38 patients, of whom 8 (21%) were bacteremic. Mean peak and trough serum levels of ceforanide drawn 1 and 11.5 h after the 0.5-g intravenous dose were 39.6 and 2.5 microgram/ml, respectively. Of the 50 patients evaluable for efficacy, all responded clinically with no serious adverse reactions. In spite of clinical improvement and in vitro susceptibility, Haemophilus influenzae persisted in the sputum of five of the eight cefazolin-treated patients and four of the five patients treated with ceforanide. Ceforanide appears to be as safe and effective as cefazolin for the therapy of pneumonia caused by S. pneumoniae or H. influenzae, but neither drug was effective in clearing H. influenzae from the sputum.

Topics: Adult; Cefamandole; Cefazolin; Cephalosporins; Clinical Trials as Topic; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Male; Pneumonia; Pneumonia, Staphylococcal; Pneumonia, Viral; Sputum; Staphylococcus

A cooperative study in 46 institutions and clinics in Tohoku and Hoddaido districts in Japan was carried out to compare the efficacy, usefulness and safety of cefamandole and cefazolin in treatment of repiratory tract infections by randomized double blind technique. Two grams of either of the two cephalosporins were given by intravenous drip infusion to the two groups of patients aged over 16 years twice a day for 14 days. Of a total of 232 patients included in the study, 120 patients were treated with cefamandole and 122 patients with cefazolin. Of these patients treated with either of the both drugs, 27 patients were excluded from evaluation for efficacy. All 232 patients were adopted for analysis of side effects. Characteristics of the population, sex and age distribution, severity of infections and infecting organisms before treatment were similar in each treatment group and no statistically significant differences could be found between the two groups. Both groups included nearly equal numbers of patients with underlying diseases or with complications. The patients pre-treated with other antibiotics before the start of the study or treated simultaneously with anti-inflammatory drugs were equally distributed in the both treatment groups. Clinical cure rate was 69.2% in groups of the patients treated with cefamandole, whereas that in cefazolin treatment group was 62.2%. Thus, there was a difference of 7% in clinical cure rate between two treatment groups, though it was not statistically significant. In groups of patients with acute bacterial pneumonia or lung abcess, clinical cure rate with cefamandole was 76.7%, whereas that with cefazolin was 67.7%. Thus, the clinical cure rate was 9% higher in the group of patients treated with cefamandole, though the difference was again statistically not significant. In the group of patients with infections associated with chronic respiratory diseases, cefamandole cured 50% of the patients treated, whereas cefazolin cured 48.1%. Comparison of the curves of cumulative distribution of MICs of cefamandole and cefazolin proved the superiority of cefamandole to cefazolin in antimicrobial activities against strains of various species isolated from the patients in the study. Rate of eradication of potential pathogenic microorganisms was 82.4% in the patients with pneumonia or lung abscess who were treated with cefamandole, whereas that with cefazolin was 83.3%. Taking efficacy and adverse effects into consideration, usef

Topics: Adult; Age Factors; Aged; Bacteria; Cefamandole; Cefazolin; Cephalosporins; Clinical Trials as Topic; Double-Blind Method; Drug Resistance, Microbial; Female; Humans; Lung Abscess; Male; Middle Aged; Pneumonia; Radiography; Respiratory Tract Infections

The efficacy and patient acceptance of i.m. cefamandole 1 000 mg 8 h and 500 mg 8 h, were compared in the treatment of assumed community-acquired pneumonia in 59 hospitalized adult patients. Of 31 patients treated with 1 000 mg 8 h, 94% had a satisfactory clinical response with a 13% bacteriological failure rate. Of 28 patients treated with 500 mg 8 h, 89% had a satisfactory clinical response with a 60% bacteriological failure rate. The only side effect registered was pain at the injection site after doses of more than 1 000 mg. The pain could be eliminated by the addition of 0.5 ml of lidocaine to the drug solution before injection.

Topics: Adult; Aged; Bronchopneumonia; Cefamandole; Cephalosporins; Clinical Trials as Topic; Female; Haemophilus influenzae; Humans; Male; Middle Aged; Pleuropneumonia; Pneumonia; Pneumonia, Pneumococcal; Proteus mirabilis; Streptococcus pneumoniae

The increasing incidence of pneumonia caused by H. influenza and the problem of beta lactamase production (18% of strains in recent reports) are important considerations in the therapy of pneumonia. An antibiotic that is effective for these strains and other common respiratory pathogens will be useful for the therapy of pneumonia. Cefamandole nafate is a new cephalosporin antibiotic with an antimicrobial spectrum similar to cephalothin with increased activity against Escherichia coli, Proteus spp., Enterobacter spp., and Haemophilus influenzae. Seventeen patients with pneumonia presumed to be due to susceptible gram-negative organisms isolated from transtracheal aspirate or sputum were treated with 6 to 8 g/day of parenteral cefamandole nafate. Organisms isolated were Haemophilus influenzae in 6, E. coli in 3, Proteus mirabilis in 2, Klebsiella pneumoniae in 1, Serratia marcescens in 1 and mixed gram-negative rods in 4. The Serratia were resistant (MIC greater than 100 microgram/ml and 50 microgram/ml): other MIC's ranged from 0.2 to 6.2 microgram/ml; median 1.6 microgram/ml. Satisfactory clinical response (improvement in pulmonary function; resolution of infiltrate; decrease in temperature, sputum production and white count) was noted in 13 of 17 patients. Two patients died from their underlying disease. Adverse clinical reactions questionably related to cefamandole included SGOT rises in 3 and rash in one. Serum antibiotic levels were 22.0 to 88.0 microgram/ml (peak) and 1.1 to 12.5 microgram/ml (trough). Sputum levels were 0.27 to 2.5 microgram/ml. Cefamandole appears to be an effective antibiotic for treatment of gram-negative pneumonia caused by susceptible organisms.

Topics: Adult; Aged; Cefamandole; Cephalosporins; Clinical Trials as Topic; Drug Resistance, Microbial; Gram-Negative Anaerobic Bacteria; Haemophilus influenzae; Humans; Klebsiella pneumoniae; Middle Aged; Pneumonia; Proteus mirabilis; Serratia marcescens

A prospective, randomized, single-blind comparison of parenteral cefamandole and ampicillin was conducted in 27 hospitalized adult patients with pneumonia or purulent tracheobronchitis due to Haemophilus spp. Patients received either parenteral cefamandole or ampicillin in a dose of 1 g every 6 h. Cefamandole was as effective and safe as ampicillin. Of the 14 patients treated with cefamandole, 13 were considered cured, as were 12 of the 13 treated with ampicillin. One patient in each treatment group improved clinically but did not clear his sputum of Haemophilus spp. One patient treated with cefamandole had a recurrence of Haemophilus spp. bronchitis 9 days after cure. Adverse effects were more common in the cefamandole-treated group (50% versus 15%), but were mild and did not require discontinuation of therapy in any patient. The in vitro susceptibilities of 64 clinical isolates of Haemophilus spp. to 10 antibiotics were determined. Cefamandole was the most active of the cephalosporin-cephamycin antibiotics tested, inhibiting 98% of 61 non-beta-lactamase-producing isolates at 2 mug/ml and 100% at 4 mug/ml. Cefamandole inhibited the three ampicillin-resistant isolates at 2 mug/ml or less. Cephapirin, cefoxitin, and cephalothin were the next most active, whereas cefazolin and cephradine were the least active.

Topics: Adult; Aged; Ampicillin; Blood Bactericidal Activity; Bronchitis; Cefamandole; Cephalosporins; Clinical Trials as Topic; Female; Haemophilus Infections; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Pneumonia

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

The aims of this study were, first, to identify risk factors for microbiology-proven postoperative pneumonia after cardiac surgery and, second, to develop and validate a preoperative scoring system for the risk of postoperative pneumonia.. A single-center cohort study.. All consecutive patients undergoing cardiac surgery between January 2006 and July 2011.. None.. Multivariate analysis of risk factors for postoperative pneumonia was performed on data from patients operated between January 2006 and December 2008 (training set). External temporal validation was performed on data from patients operated between January 2009 and July 2011 (validation set). Preoperative variables identified in multivariate analysis of the training set were then used to develop a preoperative scoring system that was validated on the validation set. Postoperative pneumonia occurred in 174 of the 5,582 patients (3.1%; 95% CI, 2.7-3.6). Multivariate analysis identified four risk factors for postoperative pneumonia: age (odds ratio, 1.02; 95% CI, 1.01-1.03), chronic obstructive pulmonary disease (odds ratio, 2.97; 95% CI, 1.8-4.71), preoperative left ventricular ejection fraction (odds ratio, 0.98; 95% CI, 0.96-0.99), and the interaction between RBC transfusion during surgery and duration of cardiopulmonary bypass (odds ratio, 2.98; 95% CI, 1.96-4.54). A 6-point score including the three preoperative variables then defined two risk groups corresponding to postoperative pneumonia rates of 1.8% (score < 3) and 6.5% (score ≥ 3).. Assessing preoperative risk factors for postoperative pneumonia with the proposed scoring system could help to implement a preventive policy in high-risk patients with a risk of postoperative pneumonia greater than 4% (i.e., patients with a score ≥ 3).

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Antibiotic Prophylaxis; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Cefamandole; Cohort Studies; Female; Humans; Logistic Models; Male; Middle Aged; Pneumonia; Postoperative Complications; Risk Assessment; Risk Factors

Topics: Anti-Bacterial Agents; Cardiac Surgical Procedures; Cefamandole; Female; Humans; Male; Pneumonia; Postoperative Complications; Risk Assessment

The frequency of community-acquired pneumonia coupled with its mortality rate of 10 to 25% is of growing concern to clinicians. A prospective study of 67 patients with severe community-acquired pneumonia was carried out to determine the causative agents, the impact fore-knowledge of the etiology has on the outcome, the value of clinical and radiologic criteria in predicting the evolution, and the efficacy of empirical therapy. The study group included 45 men and 22 women (mean age: 56.8 +/- 16.6 yr), and 46.2% suffered from a concurrent debilitating disease. The cause of pneumonia was diagnosed in 32 cases, and the most common pathogens were Streptococcus pneumoniae (37.5%), Legionella pneumophila (21.8%), and gram-negative bacilli (25.0%). The fact that fungal infections were present in three patients and Pneumocystis carinii in one are worthy of note. The overall death rate was 20.8%. A fatal outcome was related to the age of the patient (p less than 0.05), the presence of debilitating disease (p = 0.026), and septic shock (p = 0.0009). Diagnosis of the causative agents did not aid in increasing the survival rate, but it did allow for better patient management. Most of the patients (85.1%) initiated on treatment with erythromycin plus tobramycin recovered, but only 68.4% of the subjects commenced on treatment with other therapeutics survived. Furthermore, it was necessary to modify the therapy of a greater percentage of the latter group (p less than 0.025). Gram-negative bacillary pneumonia was a frequent finding among the patients who did not recover, making empirical treatment with erythromycin plus third generation cephalosporins most advisable for severe cases of community-acquired pneumonia.

Topics: Age Factors; Cefamandole; Drug Therapy, Combination; Erythromycin; Female; Humans; Legionnaires' Disease; Male; Middle Aged; Pneumonia; Pneumonia, Pneumococcal; Prospective Studies; Spain; Tobramycin

Two patients are described with severe coagulation disturbances, in one instance leading to extensive skin bleeding, secondary to the use of cefamandole. This cefalosporin antibiotic carries the same N-methylthiotetrazole side chain as moxalactam. Pathogenetic mechanisms leading to hypoprothrombinemia, its prevention and treatment are discussed.

Topics: Aged; Amputation, Surgical; Cefamandole; Diabetic Angiopathies; Female; Hemorrhagic Disorders; Humans; Hypoprothrombinemias; Kidney Transplantation; Male; Middle Aged; Pneumonia; Postoperative Complications

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

Infectious complications were studied in 14 patients who received heart-lung transplants at Stanford University Medical Center from March 1981 to November 1983. Twenty-nine infections occurred in 12 patients: 18 bacterial, nine viral, and two fungal. Sixteen (89 percent) of the bacterial infections occurred in the lung. Because of frequent colonization of the lower respiratory tract, the specificity of transtracheal aspiration and bronchoscopy was low. Empiric broad-spectrum antibiotic therapy was usually successful, and no patient died of bacterial infection. Cytomegalovirus infection occurred in six and herpes simplex virus infection in three patients. Two patients had invasive candidiasis at postmortem examination. This series emphasizes the importance of infection, particularly of the lung, in causing morbidity and mortality in heart-lung transplant recipients.

Topics: Adult; Antilymphocyte Serum; Bacterial Infections; Candidiasis; Cefamandole; Cyclosporins; Cytomegalovirus Infections; Female; Graft Rejection; Heart Transplantation; Heart-Lung Transplantation; Herpes Simplex; Humans; Lung Transplantation; Male; Methylprednisolone; Middle Aged; Pneumonia; Postoperative Care; Postoperative Complications; Premedication; T-Lymphocytes

Ceftazidime and cefamandole were compared in the treatment of pneumonia. The median MIC of ceftazidime for all Streptococcus pneumoniae (n = 17) and Haemophilus influenzae (n = 10) isolates was 0.125 microgram/ml. All other isolates were inhibited by less than 0.5 microgram of ceftazidime per ml, with the exception of a group B streptococcus (MIC = 4 micrograms/ml). Satisfactory clinical responses were observed in 91% (20 of 22) of cefamandole-treated patients and 85% (17 of 20) of ceftazidime-treated patients.

Topics: Adult; Aged; Bacteria; Cefamandole; Ceftazidime; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Pneumonia

A model of pneumonia due to Haemophilus influenzae type b was developed in mice and used for exploration of the pathophysiology of the infection and evaluation of the efficacy of five antimicrobial agents. Adult C57BL/6 mice were challenged with 3 X 10(9) cfu of H influenzae by intratracheal inoculation. Mice given placebo or no treatment experienced a uniformly bacteremic and fatal infection. Animals given ampicillin, cefamandole, chloramphenicol, erythromycin plus sulfisoxazole, or fludalanine plus pentizidone (MK 0641/MK 0642, an investigational combination drug) survived at a higher rate than did controls (P less than .001 at 72 hr for each antibiotic). However, survival rates for the various antibiotic-treated groups were similar. Viable organisms were eradicated from the lungs of antibiotic-treated mice more quickly than from the lungs of controls (P less than .001 at 24 hr for each drug). Studies of pulmonary clearance revealed significant differences among regimens; the order of efficacy (from most to least) was ampicillin, chloramphenicol, erythromycin/sulfisoxazole, cefamandole, and fludalanine / pentizidone . This model represents an appropriate system for evaluation of invasive pulmonary infection caused by H influenzae type b. Of the antibiotics assessed, ampicillin was most active in vivo.

Topics: Alanine; Ampicillin; Animals; Anti-Bacterial Agents; Cefamandole; Chloramphenicol; Drug Combinations; Drug Evaluation, Preclinical; Erythromycin; Female; Haemophilus Infections; Haemophilus influenzae; Isoxazoles; Lung; Mice; Mice, Inbred C57BL; Pneumonia; Sulfisoxazole

Topics: Age Factors; Aged; Amikacin; Cefamandole; Humans; Male; Pasteurella; Pasteurella Infections; Pneumonia

Enterococcal pneumonia occurred as a superinfection in two patients who received broad-spectrum antibiotic therapy. Both patients were receiving enteral hyperalimentation by Dobb-Hoff tube. The organism was isolated from transtracheal aspirate in pure culture and gram-positive cocci were visible on gram-stained smear. Enterococcal pneumonia may occur in patients receiving cephalosporin-aminoglycoside therapy, and may be anticipated as a consequence of third-generation cephalosporin therapy.

Topics: Aged; Aminoglycosides; Cefamandole; Cephalosporins; Drug Resistance, Microbial; Enteral Nutrition; Humans; Male; Middle Aged; Pneumonia; Streptococcal Infections

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

Cardiopulmonary resuscitation was successful in a healthy 29-year-old woman who had been submerged for 20 minutes in water at 10 degrees C. The evolution was characterized by the development of a multifactorial ARDS (secondary drowning) and sepsis caused by Aeromonas hydrophila and Acinetobacter anitratum. Fibrosing alveolitis caused a restrictive syndrome with severe mechanical impairment and transitory therapy-resistant hypoxemia. It is suggested that prolonged submersion in cold water is also a treatable and completely reversible condition in adults. In our patient without neurological sequelae the pulmonary function studies after 3 months show complete recovery from the mechanical impairment. After a follow-up period of 11 months only mild abnormalities of gas exchange persist.

Topics: Adult; Cefamandole; Cold Temperature; Cytomegalovirus Infections; Drowning; Female; Humans; Hypoxia; Lung; Pneumonia; Positive-Pressure Respiration; Pulmonary Edema; Pulmonary Fibrosis; Radiography; Resuscitation; Tobramycin; Transfusion Reaction

Topics: Aged; Anti-Bacterial Agents; Cefamandole; Cephalosporins; Humans; Penicillin G; Pneumonia

Moxalactam was evaluated in the therapy of lower respiratory tract infections in 40 patients. The most common organisms isolated were Streptococcus pneumoniae (37.2%) and Haemophilus influenzae (21.5%). Gram-negative enteric organisms were isolated from six patients. No patient was evaluated as a treatment failure; however, two patients died of unrelated causes either during therapy or in the immediate posttherapy period. We determined the comparative minimal inhibitory concentrations of moxalactam, cefamandole, and cephalothin for our aerobic clinical isolates. Susceptibilities of the anaerobic isolates were measured by the Kirby-Bauer method. All isolates were susceptible to moxalactam. Moxalactam was found to be highly effective in the therapy of lower respiratory tract infections.

Topics: Adult; Aged; Bacteria; Bacterial Infections; Cefamandole; Cephalosporins; Cephalothin; Cephamycins; Drug Resistance, Microbial; Female; Humans; Male; Middle Aged; Moxalactam; Pneumonia; Species Specificity

A woman with rheumatoid arthritis and ampicillin-resistant Haemophilus influenzae type b (Hib) pneumonia complicated by bacteremia and empyema is reported. Initial therapy with cefamandole failed to eliminate bacteria from the pleural space and did not substantially affect the clinical course. However, cultures became negative and fever resolved when therapy was changed to chloramphenicol. Ampicillin-resistant Hib pneumonia in adults is an increasing problem and may be a difficult diagnosis to establish initially. Counterimmunoelectrophoresis may be useful in adults with pneumonia. If Hib antigen is detected, or if H influenzae is suspected on the basis of Gram stains and cultures, chloramphenicol should be given until the isolate is shown to be sensitive to ampicillin.

Topics: Ampicillin; Cefamandole; Cephalosporins; Chloramphenicol; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Middle Aged; Penicillin Resistance; Pneumonia

A 66-year-old man had pneumonia, lung abscesses, and mediastinal adenopathy develop due to Yersinia enterocolitica. There was no evidence of septicemia or acute gastrointestinal disease. Diagnosis was confirmed by cultures of a transtracheal aspirate and sputum. Treatment with cefamandole nafate, which had not been used previously in Y enterocolitica lung disease, resulted in cure.

Topics: Aged; Cefamandole; Humans; Lung Abscess; Lung Diseases; Male; Pneumonia; Yersinia Infections

Ceforanide (BL-S 786) is a new long-acting parenteral cephalosporin which has the major pharmacologic advantage of requiring only twice a day dosage. We treated 28 adult patients with community-acquired bacterial pneumonia using doses of 500 or 1000 mg every 12 hours. Twenty-four of 28 infections were due to Streptococcus pneumoniae and/or Hemophilus influenzae, and all pathogens were susceptible in vitro to both cephalothin and ceforanide. Patients were treated for a mean of 7.5 days, and all showed a good clinical and radiographic response with no mortality. Of the 13 patients with H. influenzae, the organism could still be recovered during therapy in 9/12 and post therapy in 3/8. One clinical superinfection (sepsis due to Pseudomonas aeruginosa) occurred during therapy. Side effects with therapy included thrombocytosis (15), asymptomatic eosinophilia (5), and mild elevation of the serum transaminases (3). These studies suggest that ceforanide is a safe and effective agent for the treatment of adult patients with bacterial pneumonia due to S. pneumoniae; further experience in therapy of H. influenzae is needed because of frequent failure of ceforanide to eradicate this organism from the sputum.

Topics: Adult; Cefamandole; Cephalosporins; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Injections, Intramuscular; Injections, Intravenous; Male; Pneumonia; Pneumonia, Pneumococcal

The authors have carried out the laboratory and clinical studies of cefamandole (CMD). The results are as follows: The sensitivity was measured by plate dilution method on 26 strains of Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae and 14 strains of Salmonella typhimurium isolated from patients. The distribution of sensitivity of S. aureus was 0.39 approximately 3.13 micrograms/ml and the peak of distribution was 1.56 micrograms/ml. The distribution of sensitivity of E. coli was 0.78 approximately greater than 100 micrograms/ml, and K. pneumoniae, 1.56 approximately greater than 100 micrograms/ml. The distribution of sensitivity of Salmonella typhimurium was 6.25 approximately greater than 100 micrograms/ml and its peak was 6.25 micrograms/ml. CMD were given intravenously for 30 and 60 minutes at a single dose of 25 mg/kg body weight to 6 children. The serum mean levels of CMD were 105.3 micrograms/ml at 30 minutes, 15.1 micrograms/ml at 1.5 hours, 1.6 micrograms/ml at 2.5 hours after drip infusion for 30 minutes, respectively, and 34.7, 5.2, 0.6 micrograms/ml at 1, 2, 3 hours after drip infusion for 60 minutes, respectively. And the serum level at 4 hours after administration was not detected. The mean urinary excretion rates were 73.3% in the drip infusion for 30 minutes and 60.7% in its for 60 minutes, up to 8 hours after administration. Half life was 26 minutes. CMD was effective in 18 of 21 cases of bacterial infections. No side effects were observed except for 2 cases with elevation of serum transaminase.

Topics: Bacterial Infections; Cefamandole; Cephalosporins; Child; Child, Preschool; Drug Resistance, Microbial; Escherichia coli; Female; Humans; Infant; Klebsiella pneumoniae; Male; Microbial Sensitivity Tests; Pneumonia; Salmonella typhimurium; Staphylococcus aureus; Tonsillitis

Topics: Bacterial Infections; Cefamandole; Cefazolin; Cephalosporins; Child; Child, Preschool; Drug Resistance, Microbial; Escherichia coli; Female; Humans; Infant; Infant, Newborn; Infusions, Parenteral; Male; Meningitis, Aseptic; Microbial Sensitivity Tests; Pneumonia; Staphylococcus aureus; Urinary Tract Infections

Community-acquired bacterial pneumonia in the elderly has for years been attributed almost exclusively to Streptococcus pneumoniae. Recent technical advances have provided bacteriologic and epidemiologic data demonstrating that other pathogens are important causes of pulmonary infection in older patients. This report reviews these data and reappraises the conventional therapy of community-acquired bacterial pneumonia in geriatric patients. Some properties of a new antibiotic, cefamandole nafate, are described.

Topics: Adult; Aged; Bacterial Infections; Cefamandole; Cephalosporins; Humans; Nursing Homes; Pneumonia

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

Fifty-three infants and children, aged three months to 15 years, were treated with an average daily dose of 100 mg of cefamandole/kg intravenously. Of these patients, 47 had soft tissue cellulitis and six had pneumonia. Primary pathogens, including Staphylococcus aureus, Streptococcus pyogenes, Streptococcus pneumoniae, and Haemophilus influenzae, were isolated from 43 of the 53 patients. Bacteremia was documented in six of the 53 patients. A satisfactory clinical and bacteriologic response to cefamandole was achieved in all cases except on (98%). The only treatment failure occurred in an infant with both periorbital cellulitis and bacteremia due to H. influenzae who developed meningitis while receiving cefamandole; no extravasation of the drug across the blood-brain barrier could be detected in spite of inflamed meninges. In general, the only aberrant effects of cefamandole were the appearance of eosinophilia in 28% of patients and a positive indirect Cooms' test without hemolysis in one patient. Cefamandole showed excellent in vitro activity against 87 ampicillin-resistant strains of H. influenzae. Because it has greater activity than any of the other cephalosporins against this important pediatric pathogen, cefamandole may have particular pertinence in the treatment of infections in infants and young children.

Topics: Adolescent; Bacterial Infections; Cefamandole; Cellulitis; Cephalosporins; Child; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Pneumonia; Pneumonia, Pneumococcal; Staphylococcal Infections; Streptococcal Infections

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

Cefamandole, a new cephalosporin antibiotic, has greater activity against common pathogens, including Escherichia coli, Haemophilus influenzae, and Proteus (including indole-positive strains), than available cephalosporin drugs. We have evaluated the safety and pharmacokinetics of this drug in 30 infants and children. Blood levels and urinary excretion of the drug were similar to those previously found in adults. The only side effects were mild and transient elevation of serum glutamic oxalacetic transaminase in 12 patients and of blood urea nitrogen in 1 patient in whom serum creatinine remained normal and unchanged.

Topics: Adolescent; Cefamandole; Cephalosporins; Child; Child, Preschool; Drug Evaluation; Female; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Male; Pneumonia; Urinary Tract Infections