cefotaxime and Diabetic-Angiopathies

Orthopedic deformations of the feet play an important role in the etiology of the foot ulcers of diabetic patients, together with neuropathy and vascular impairment. The employment of new techniques in the treatment of diabetic foot has considerably improved its prognosis. These are the transient circulatory blockade (TCB) and the regional intravenous antibiotic administration (RAA). This paper reports on the usage of these techniques in the treatment of 24 diabetic patients, 8 women with ages between 41 and 75 (mean 54.7) years, and 16 men with ages between 41 and 75 (mean 59.3) years who were operated on 29 opportunities because of foot ulcer. Most of the patients had different grades of foot infection. Neuropathy was present in all cases and a distal type of arterial occlusion was diagnosed in 8 cases. Foot surgery was performed under regional i.v. anesthesia associated with regional i.v. injection of 1 g Cefotaxine (Calaforan) in 250 ml saline solution which was administered through the same butterfly needle used for the regional anesthesia. The drainage of the foot infection was performed simultaneously with the orthopedic correction of the foot deformities. All patients healed without complications attributable to the bone surgery. Patients operated upon while complicated with foot phlegmons remained longer (31 days) in the hospital than those without infection (18 days). After a follow-up period of 4.7 (1 to 8) years there were 2 recurrencies and 3 patients developed new foot ulcers. All patients were using a normal, soft shoe. We conclude that the TCB and the RAA facilitate orthopedic surgery in diabetic patients with foot ulcers improving their life quality and prognosis.

Topics: Adult; Aged; Anesthesia, Conduction; Cefotaxime; Chemotherapy, Cancer, Regional Perfusion; Combined Modality Therapy; Diabetic Angiopathies; Diabetic Neuropathies; Female; Follow-Up Studies; Foot Ulcer; Hallux Valgus; Humans; Male; Middle Aged; Postoperative Care; Wound Healing

15 patients with severe diabetic gangrene were treated with a combined intra-arterial PGE1/Cefotaxime infusion therapy. There was no indication for vascular reconstructive surgery. The average treatment took 24.7 days. 11 of the 15 patients were responsive to the therapy. Nevertheless 5 of these 11 patients had to be amputated below-knee in the further course of treatment. In 6 cases we succeeded in preserving the affected extremity in a state of acceptable use. One patient died during the study. No complications due to the therapy were seen. Considering that all patients were near to amputation when entering the study the result to have saved the extremities in 40% of the cases must be regarded as a success.

Topics: Alprostadil; Cefotaxime; Diabetic Angiopathies; Foot; Foot Diseases; Gangrene; Humans; Infusions, Intra-Arterial

Topics: Bacterial Infections; Cefotaxime; Diabetic Angiopathies; Gangrene; Humans; Injections, Intra-Arterial; Osteomyelitis; Sepsis

Plasma concentrations of cefotaxime and desacetyl cefotaxime were determined by HPLC in geriatric patients with multiple diseases. Comparison with a younger control group of healthy volunteers showed a prolongation of half-life of CTX and dCTX in the older patients. A significant correlation between pharmacokinetic parameters of dCTX and other clinical and chemical parameters was found. Half-life of dCTX was positively correlated with age of the geriatric patients (P less than 0.05). There was also a significant relationship between CHE in serum and plasma peak concentrations of dCTX. Time until reaching plasma peak concentrations correlated closely with total bilirubin (P less than 0.01), CHE (P less than 0.001), cholesterol (P less than 0.01), and urea (P less than 0.01). Accumulation of the pharmacologically active metabolite dCTX could not be excluded in one patient with kidney disease. In accordance with other investigators it is recommended to reduce the dose of cefotaxime in geriatric patients with kidney diseases.

Topics: Aged; Arteriosclerosis; Cefotaxime; Diabetes Complications; Diabetes Mellitus; Diabetic Angiopathies; Female; Half-Life; Heart Failure; Humans; Hypertension; Kidney Diseases; Kinetics; Male; Pneumonia; Urinary Tract Infections