cefamandole and Sepsis

Timentin (ticarcillin + clavulanic acid) and cefamandole were compared in 484 patients undergoing elective thoracic or vascular surgery. Two hundred and forty eight patients received three 3 g/200 mg injections of Timentin and 236 patients received three 0.75 g injections of cefamandole. The patients were evaluated at discharge. Among the 248 patients given Timentin, only six (2.4%) had a post-operative infection, while nine (3.8%) of the 236 patients given cefamandole had a post-operative infection. There was no statistically significant difference between the two treatment regimes. This comparative study shows that Timentin may be used for antibiotic prophylaxis of clean vascular or thoracic surgery.

Topics: Bacteria; Cefamandole; Clavulanic Acids; Clinical Trials as Topic; Drug Combinations; Humans; Penicillin Resistance; Penicillins; Premedication; Prospective Studies; Random Allocation; Sepsis; Surgical Wound Infection; Thoracic Surgery; Ticarcillin; Vascular Surgical Procedures

Topics: Cefamandole; Clinical Trials as Topic; Drug Evaluation; Drug Therapy, Combination; Humans; Respiratory Tract Infections; Sepsis; Tobramycin

Antibiotic prophylaxis in kidney transplantation is controversial. In a prospective controlled study, 34 cadaveric kidney transplant recipients were investigated. Antibiotic prophylaxis was given in a random order to 16 patients whereas 18 without prophylaxis served as controlls. In 4 of 20 investigated clinical parameters statistically significant differences were found between both groups: the controlls happened to have better initial conditions; perioperative and postoperative better initial conditions; perioperative and postoperative infections were less frequent in the prophylaxis group and more antibiotics postoperatively were needed in the controlls. These findings indicate that antibiotic prophylaxis has a beneficial effect in kidney transplantation.

Topics: Bacteriological Techniques; Catheters, Indwelling; Cefamandole; Clinical Trials as Topic; Humans; Kidney Transplantation; Premedication; Random Allocation; Sepsis; Surgical Wound Infection; Urinary Tract Infections

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

Two hundred twenty patients were randomly assigned to receive either ceforanide or cephalothin as perioperative antibiotic prophylaxis during cardiovascular surgery. More infections were seen among cephalothin recipients (8 deep, 32 total) than among ceforanide recipients (1 deep, 17 total). Among patients who had only coronary artery bypass grafting, more cephalothin recipients had infection than did ceforanide recipients (19 of 82 as opposed to 7 of 83; p = 0.001; relative risk, 2.7; 95% confidence interval, 1.22 to 6.18). The difference between the two regimens was attributable to fewer blood, wound, and urinary tract infections. Among patients who had other procedures, there was no difference in the efficacy of the two regimens. Cephalothin recipients who developed wound or blood stream infections had lower antibiotic levels in their atrial appendages than recipients not developing such infections (p = 0.02). If one assumes that cephalothin does not increase the risk of infection, then these data show that antibiotic prophylaxis prevents infection after coronary artery bypass surgery, and, in the dosages used, that ceforanide is superior to cephalothin.

Topics: Cefamandole; Cephalothin; Clinical Trials as Topic; Coronary Artery Bypass; Double-Blind Method; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Myocardium; Postoperative Complications; Premedication; Random Allocation; Respiratory Tract Infections; Risk; Sepsis; Surgical Wound Infection; Urinary Tract Infections

Eighty adult patients with microbiologically demonstrated staphylococcal infections were included in a comparative trial of cefamandole and cefamandole plus tobramycin. Patients with cefamandole-resistant pathogens were treated with vancomycin, if the initial therapy consisted of cefamandole, but were continued on cefamandole plus tobramycin if already started on that combination. Of the patients infected with cefamandole-susceptible strains, 91% (20/22) responded favorably to treatment with cefamandole alone, and 88% (30/34) responded favorably to cefamandole plus tobramycin. Of the patients infected with cefamandole-resistant staphylococci, 70% (7/10) responded to treatment with cefamandole plus tobramycin, and 86% (12/14) responded to treatment with vancomycin, even though vancomycin therapy was started 24 to 48 h later than cefamandole-plus-tobramycin therapy. No major side effects were observed; however, cefamandole plus tobramycin was associated with a rise in the serum creatinine level in 11% (4/44) of the patients. The bactericidal activity of the serum in cefamandole-treated patients and in cefamandole-plus-tobramycin-treated patients was identical against cefamandole-susceptible strains. Against cefamandole-resistant strains, 87% of the vancomycin-containing sera were bactericidal at a dilution of 1:8, whereas only 57% of the cefamandole-plus-tobramycin-containing sera were active at that dilution.

Topics: Anti-Bacterial Agents; Cefamandole; Cephalosporins; Drug Therapy, Combination; Humans; Methicillin; Penicillin Resistance; Sepsis; Staphylococcal Infections; Staphylococcus; Tobramycin; Vancomycin

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

Topics: Adolescent; Adult; Aged; Bile; Cefamandole; Cephalosporins; Cephalothin; Cholecystectomy; Double-Blind Method; Escherichia coli Infections; Female; Humans; Male; Middle Aged; Premedication; Prospective Studies; Random Allocation; Risk; Sepsis; Surgical Wound Infection

A prospective randomized clinical trial was carried out to evaluate the role of parenteral antibiotics in elective operations upon the colon. All patients received a mechanical intestinal preparation, neomycin and erythromycin base orally and topical antibiotic administration intra-abdominally and to the wound at the time of operation. The patients were further randomized into three groups. One group received no parenteral antibiotics; the second group received parenteral cefamandole, and the third group received parenteral penicillin, gentamicin and clindamycin. One hundred and thirteen patients completed the study. The sepsis rate postoperatively was similar for all three groups. When oral and topical antibiotics are used in elective operations upon the colon, parenteral antibiotics provide no additional benefit.

Topics: Anti-Bacterial Agents; Cefamandole; Clindamycin; Colon; Drug Therapy, Combination; Erythromycin; Gentamicins; Humans; Neomycin; Penicillins; Polymyxin B; Premedication; Prospective Studies; Random Allocation; Sepsis; Surgical Wound Infection

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

The experience with empirical antimicrobial therapy of septicemia and febrile episodes in pediatric neutropenic patients was analyzed retrospectively. Between January 1985 and March 1988 in 49 patients 77 episodes were observed. Bacteremia was found in 15 (20%), culture proven localized bacterial infection in 11 (14%) and clinically diagnosed bacterial infection was found in 7 (9%) of the febrile episodes. Thus, 33 (43%) documented bacterial infections were observed. For initial therapy a combination of aminoglycoside plus 2nd/3rd generation cephalosporin (60%) or aminoglycoside plus piperacillin (30%) was usually chosen. Both regimens were equally effective. 52% and 56%, respectively, were sufficiently treated with the initial regimen. 95% of all episodes resolved completely, the mortality rate was 5%. Central venous catheters remained in situ in 84% of the cases. The period of time necessary for recovery of granulopoiesis had an influence on the therapy success.

Topics: Adolescent; Agranulocytosis; Antineoplastic Agents; Cefamandole; Cefotaxime; Child; Child, Preschool; Drug Therapy, Combination; Female; Fever of Unknown Origin; Gentamicins; Humans; Infant; Infusion Pumps; Leukocyte Count; Male; Neoplasms; Neutropenia; Piperacillin; Sepsis

Ninety-two microbiologically documented staphylococcal infections were treated with cefamandole in an open comparative study on the clinical efficacy of this cephalosporin in the therapy of infections caused by both methicillin-susceptible and methicillin-resistant Staphylococcus aureus and coagulase-negative Staphylococcus spp. The majority of the episodes (86 of 92) were treated with cefamandole alone, and six were treated with cefamandole in association with other antibiotics. In the evaluable S. aureus infections, 34 of 46 (73.9%) due to methicillin-susceptible strains and 12 of 16 (75%) due to methicillin-resistant strains responded to therapy. In particular, among the patients infected by methicillin-susceptible S. aureus 6 of 9 cases of septicemia, 0 of 2 cases of endocarditis, 2 of 2 cases of pneumonia, 2 of 3 osteoarticular infections, 8 of 12 cases of peritonitis in patients with chronic renal failure in continuous ambulatory peritoneal dialysis (CAPD), 13 of 15 skin-soft tissue infections, and 3 of 3 urinary tract infections responded to therapy. Among those due to methicillin-resistant strains, cure was achieved in 2 of 4 cases of septicemia, 0 of 1 case of endocarditis, 9 of 10 skin-soft tissue infections, and 1 of 1 urinary tract infection. In the evaluable infections caused by coagulase-negative staphylococci, 9 of 11 (81.8%) due to methicillin-susceptible and 15 of 17 (88.2%) due to methicillin-resistant strains responded to therapy. In particular, among patients infected by methicillin-susceptible, coagulase-negative staphylococci, 4 of 4 cases of septicemia, 0 of 1 case of endocarditis, 1 of 1 case of pneumonia, 1 of 1 case of peritonitis in CAPD, 2 of 3 infections of skin-soft tissue, and 1 of 1 urinary tract infection responded to therapy. Among patients infected by methicillin-resistant, coagulase-negative staphylococci were cured 5 of 6 cases os septicemia, 6 of 6 cases of peritonitis (in CAPD), 4 of 4 infections of skin-soft tissue, and 0 of 1 urinary tract infection.

Topics: Adult; Aged; Cefamandole; Coagulase; Female; Humans; Male; Methicillin; Middle Aged; Penicillin Resistance; Sepsis; Staphylococcal Infections

The in vitro activity of cefonicid against 60 strains of viridans group streptococci isolated from blood of patients with bacteremia and infective endocarditis was compared with those of cefazolin and penicillin. Cefonicid was less active than cefazolin, and both cephalosporins were less active than penicillin. The MIC50 and MIC90 for the strains tested were 0.06 and 1 microgram/ml for penicillin, 0.125 and 8 micrograms/ml for cefazolin, and 4 and 32 micrograms/ml for cefonicid.

Topics: Cefamandole; Cefazolin; Cefonicid; Endocarditis, Bacterial; Humans; Microbial Sensitivity Tests; Penicillins; Sepsis; Streptococcal Infections; Streptococcus

Topics: Aged; Cefamandole; Clostridium Infections; Enterococcus faecalis; Enterocolitis, Pseudomembranous; Humans; Male; Sepsis; Streptococcal Infections

The correlation between in vitro antimicrobial activity and the in vivo response to antimicrobial therapy is affected by multiple host factors, the site and nature of the infection, and the pharmacokinetics of the antimicrobial and its penetration into areas of infection. In certain instances, discrepancies are also caused by methodologically-related variables of in vitro susceptibility tests. Examples of discrepancies between in vitro and in vivo response to antimicrobial are discussed.

Topics: Anti-Bacterial Agents; Bacteria; Bacteria, Anaerobic; Bacteroidaceae; Bacteroides; Bacteroides Infections; Cefamandole; Chloramphenicol; Clindamycin; Enterobacter; Enterobacteriaceae; False Positive Reactions; Haemophilus influenzae; Humans; Microbial Sensitivity Tests; Pseudomonas aeruginosa; Sepsis; Staphylococcus; Sulfamethoxazole; Trimethoprim

Topics: Anti-Bacterial Agents; Cefamandole; Cephalosporins; Drug Therapy, Combination; Humans; Oxacillin; Penicillin Resistance; Sepsis; Staphylococcal Infections; Tobramycin; Vancomycin

The ability of cefoxitin to antagonize the in vivo efficacy of cefamandole and carbenicillin as predicted by in vitro assays was analyzed in experimental infections in mice. Cefoxitin was administered in a nonprotective dose either at the time of challenge or simultaneously with the protective drug, 1 and 3.5 h postchallenge. In mice infected with Enterobacter cloacae, median 50% protective doses of cefamandole and carbenicillin were markedly increased by cefoxitin, especially when the latter was given at the time of challenge. The antagonistic effect was also associated with increased numbers of challenge bacteria present in animal heart blood within a 6.5-h period after infection. In infections with Pseudomonas aeruginosa, cefoxitin antagonized carbenicillin; however, the effect was less dramatic than that seen with E. cloacae. Antagonism in this model was pronounced with simultaneous administration of antagonizing and protective drugs. The antagonistic effects observed in all in vivo tests were not due to the selection of stable resistance to the protective drugs, but appeared to be due to a reversible induction of beta-lactamases by cefoxitin.

Topics: Animals; Bacterial Infections; Carbenicillin; Cefamandole; Cefoxitin; Cephalosporins; Lactams; Male; Mice; Penicillin Resistance; Sepsis

Topics: Ampicillin; Cefamandole; Cephalosporins; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Penicillin Resistance; Sepsis

The efficacy of cefamandole in the treatment of 19 patients with salmonella bacteremia was evaluated. Although all of the salmonella strains isolated were highly susceptible to cefamandole in vitro, a therapeutic failure was observed in 7 (36.8%) of the 19 patients.

Topics: Cefamandole; Cephalosporins; Dose-Response Relationship, Drug; Drug Resistance, Microbial; Humans; Salmonella Infections; Salmonella typhi; Sepsis

Topics: Adult; Bacteroides fragilis; Bacteroides Infections; Cefamandole; Cephalosporins; Female; Humans; Male; Sepsis

Cefamandole is a second-generation cephalosporin with a high level of activity against common aerobic pathogens, both Gram-positive and Gram-negative. Eighty-five per cent of 20 recent clinical isolates of Bacteroides fragilis are sensitive and these data allied with its known activity against common aerobes reinforce its recommendation for the prophylaxis and treatment of severe hospital infections, particularly post-surgical cases with septicaemia.

Topics: Anti-Bacterial Agents; Bacteria; Bacteroides fragilis; Cefamandole; Cephalosporins; Child; Humans; Sepsis; Species Specificity

Procedures for evaluating the efficacy of chemotherapeutic agents in an infant rat model of Haemophilus influenzae meningitis were developed. The results of efficacy studies with ampicillin, chloramphenicol, cefamandole, cefoxitin, and SQ 13,426 were compared to activity in vitro. While most of the drugs tested were very active against the two strains of H. influenzae used in vitro, this activity was not in all cases translated into efficacy in vivo. Pharmacokinetic studies using ampicillin or chloramphenicol demonstrated the presence of each antibiotic at the foci of infection in concentrations found to be bactericidal in vitro.

Topics: Ampicillin; Animals; Cefamandole; Cefoxitin; Cephalosporins; Chloramphenicol; Drug Evaluation, Preclinical; Haemophilus influenzae; Meningitis, Haemophilus; Microbial Sensitivity Tests; Rats; Sepsis

To compare the in vitro activity of cefamandole with ampicillin, cefoxitin, and gentamicin, each antimicrobial was tested against 419 bacteria isolated from the blood of patients with proved sepsis. Cefamandole was active against all gram-positive cocci except the enterococci. Most Enterobacteriaceae were inhibited by both cefamandole and cefoxitin. Cefamandole showed an activity similar to ampicillin against Haemophilus influenzae. The percent of blood culture isolated considered susceptible to the drugs tested were as follows: cefamandole 79%, cefoxitin 78%, ampicillin 55% and gentamicin 81%. None of the drugs tested would be adequate alone for treatment of sepsis of unknown etiology based on in vitro susceptibility data.

Topics: Ampicillin; Anti-Bacterial Agents; Bacteria; Cefamandole; Cefoxitin; Gentamicins; Humans; Microbial Sensitivity Tests; Sepsis

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

Forty-four patients with serious bacterial infections were treated with cefamandole in a dose 1--2 g every four to six hours. Thirty-two patients were cured and six were markedly improved. Three of six failures were due to superinfection with cephalothin-resistant microorganisms. The over-all bacteriologic response was 80%. In 12 of 13 patients with bacteremia the blood was sterilized. Ten of 14 patients with gram-negative bacillary infections responded to treatment. Six of these were due to cephalothin-resistant microorganisms, three of which responded. Fifteen patients who were treated had a history of penicillin allergy. There were no serious reactions although skin rash did develop. Phlebitis was uncommon.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefamandole; Cephalosporins; Enterobacteriaceae Infections; Escherichia coli Infections; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Male; Middle Aged; Sepsis; Staphylococcal Infections; Streptococcal Infections

The combination of carbenicillin plus cefamandole was administered to 88 patients with cancer during 116 evaluable episodes of fever. The overall response rate to carbenicillin plus cefamandole for the 116 episodes was 57%. There were 60 documented infections, of which 60% responded to this combination of antibiotics. The response rate was only 43% in patients with pneumonia. The etiologic agent was identified during 38 infections, of which 74% responded to carbenicillin plus cefamandole. Responses occurred less frequently in patients with neutropenia than in those without neutropenia and less frequently in patients whose infection was caused by organisms resistant to both antibiotics than in those with infection caused by organisms sensitive to one or both of the drugs. No side effects could be attributed to the antibiotic regimen.

Topics: Adolescent; Aeromonas; Aged; Bacterial Infections; Carbenicillin; Cefamandole; Cephalosporins; Corynebacterium Infections; Drug Therapy, Combination; Enterobacteriaceae Infections; Female; Flavobacterium; Humans; Listeriosis; Male; Middle Aged; Neoplasms; Respiratory Tract Infections; Sepsis; Tobramycin