cefotaxime and Leg-Ulcer

Over a 6-month period 124 patients submitted to aortic or infra-inguinal arterial reconstruction were alternately allocated to receive cloxacillin plus gentamicin (CX/GM) for 48 hours or cefotaxime (CTX) for 24 hours perioperatively. Evaluations during during the first month were performed by a blinded independent observer and patients were followed for between 6 and 20 months. 63 patients received CX/GM and 61 CTX; the groups were matched for sepsis risk factors. Sepsis rates were: groin and abdominal wounds, CX/GM 5.4% (7 of 129), CTX 6.2% (8 of 127); graft, CX/GM 1.5% (1 of 63), CTX 3.3% (2 of 61). The differences were not statistically significant (p greater than 0.05). Virtually all wound infections were superficial (class I) and no late infections have emerged. 56 patients had infected extremity lesions and 68 had no lesion. There was no significant difference in wound or graft sepsis rates between the 2 groups. Positive cultures of groin lymph nodes and/or aortic clot or atheroma did not predispose patients to postoperative sepsis. The organisms cultured from the extremity lesions were not found in infected wounds of abdominal surgery patients. However, species type and antibiotic susceptibility patterns suggest that the same pathogens were present in wound infections as were isolated from the extremity lesions of patients who underwent infra-inguinal surgery. Thus direct, rather than lymphatic, contamination may be the major aetiological factor. Most infecting organisms were susceptible to the antibiotic used.

Topics: Adult; Aged; Aged, 80 and over; Arterial Occlusive Diseases; Cefotaxime; Cloxacillin; Drug Therapy, Combination; Female; Follow-Up Studies; Gangrene; Gentamicins; Humans; Leg Ulcer; Middle Aged; Prospective Studies; Surgical Wound Infection

In patients with peripheral arterial occlusive disease, it is difficult to attain an adequate antibiotic concentration in poorly perfused infected lesions. The antibiotic concentrations prevailing in the ulcer secretion with the different routes of administration were investigated in 7 patients. The patients received 1 g of cefotaxim on consecutive days: intravenously on the first day, intraarterially on the second day and by retrograde venous injection on the third day. Significantly higher concentrations in the secretion were found after retrograde venous antibiotic administration than after intravenous or intraarterial injection. Clinical experience up to now indicates that far better results of treatment can be attained if the antibiotic is administered by retrograde venous injection (in addition to the surgical measures required).

Topics: Biological Availability; Cefotaxime; Chemotherapy, Cancer, Regional Perfusion; Humans; Infusions, Intra-Arterial; Infusions, Intravenous; Ischemia; Leg Ulcer; Male; Metabolic Clearance Rate; Middle Aged

We evaluated the concentration of cefotaxime in the exudate from ischemic leg ulcers in 9 subjects with severe obstructive arterial disease. The administration of the drug was either systemic (1 g in 250 ml of saline given in 30 min) or regional at a vein of the foot while a tourniquet was applied at the level of the thigh during 30 min. Hygroscopic discs were used to collect samples of ulcer exudate at hourly intervals for 4 hr. Cefotaxime concentration was determined by HPL chromatography. A significantly greater concentration of antibiotic was obtained with regional as compared to systemic administration (46 +/- 16 vs 25 +/- 14, p less than 0.01) and a greater percentage of patients attained MIC 90. A stable concentration of the drug was observed during the 4 hr period indicating a decreased rate of elimination of the antibiotic from the ulcer tissue. Thus, regional administration of antibiotics affords greater concentration than systemic administration, for treatment of ischemic leg ulcers.

Topics: Adult; Aged; Cefotaxime; Cephalosporins; Diabetes Complications; Diabetes Mellitus; Exudates and Transudates; Female; Humans; Infusions, Intravenous; Leg Ulcer; Male; Middle Aged