cefotaxime and Prostatic-Diseases

Several previous studies have attested to the value of antibiotic prophylaxis for prostatic surgery. We report a prospective randomised study which compared a single dose of cefotaxime with a single dose of cephradine given with the induction of anaesthesia. There was little difference between these regimens and it was concluded that either may be used, depending on availability and cost of the antibiotic. We have now completed a 5-year study of antibiotic prophylaxis for prostatic surgery and we also report the results of a long-term survey of the ward flora. There has been no significant change and there is no evidence for the emergence of resistant strains.

Topics: Aged; Cefotaxime; Cephalosporins; Cephradine; Clinical Trials as Topic; Humans; Male; Premedication; Prospective Studies; Prostate; Prostatic Diseases; Random Allocation

The effect on bacteriologically documented postoperative infection of flash prophylaxis using two intravenous injections of 20 mg/kg cefotaxime each was evaluated in a double blind, randomized trial against placebo. 181 participants free of urinary tract infection prior to surgery had either transurethral prostatic resection (TUR) (n = 90) or open prostatectomy (OP) (n = 91). Urine samples, blood samples, prostate specimens and skin swabs were investigated for pathogens. Rate of urinary tract infection was significantly reduced by cefotaxime (CTX) prophylaxis in both groups. CTX lowered the incidence of early postoperative urinary tract infection from 30% to 4% in TURs and from 46% to 4.5% in OPs. Similarly, a significant difference was demonstrated for incidences of intra and postoperative bacteremia. In open prostatectomy patients, a reduced rate of wound infection and shorter hospital stay were noted in the treated group. Pathogens recovered in this study were Streptococcus (29%), Staphylococcus (20.5%), Enterobacteriaceae (45.75%), Pseudomonas (1.25%), Acinetobacter (3%), and Bacteroides fragilis (0.5%). CTX prophylaxis apparently has no bearing on postoperative emergence of resistant pathogens. Percentage of resistance to CTX in delayed postoperative infections was 33% in the control group and 35% in the treated group. We conclude that flash CTX prophylaxis in transurethral or open prostatectomy is of benefit in reducing morbidity and hospital costs.

Topics: Bacterial Infections; Cefotaxime; Clinical Trials as Topic; Double-Blind Method; Humans; Male; Postoperative Complications; Prostate; Prostatectomy; Prostatic Diseases; Random Allocation; Sepsis; Urinary Tract Infections; Wound Infection

Cefmenoxime, a new cephalosporin, was given to fifty patients (28 male and 22 female) aged 15 to 86 years with infection of the urinary tract or prostate. Urinary tract infections, i.e. cystitis in 20 cases and pyelonephritis in 21, were usually chronic and associated with urologic anomalies. Nine patients had infection of the prostate. Pathogens recovered from the urine were 26 E. coli, 8 Klebsiella, 16 Serratia, 5 Proteus mirabilis or indole-positive Proteus, 1 Providencia, and 4 Pseudomonas. Minimal inhibitory concentrations of cefmenoxime ranged from 0.015 to 64 micrograms/ml (mean MIC: 0.12 micrograms/ml). Cefmenoxime was given as single drug therapy in all patients but one, in a daily dosage of 2 g divided into two intramuscular injections, for 3 to 28 days (average 22 days). Follow-up after discontinuation of treatment was four weeks. Therapeutic results were as follows: 13 successes and 7 failures by relapse for the 20 cystitis patients, 13 successes and 7 failures by relapse for the 20 interpretable cases of pyelonephritis, and 4 successes and 5 failures by relapse for the 9 patients with prostate infection. Local tolerance was excellent. Skin rash in 2 patients and diarrhea in 1 required withdrawal of the drug. Three other patients with diarrhea were able to continue treatment. Intolerance to ingestion of alcoholic beverages was reported by 10 patients. Hypereosinophilia was recorded in 2 cases and a transient mononucleosic reaction in one. No renal of hepatic side effects were documented.

Topics: Adolescent; Adult; Aged; Cefmenoxime; Cefotaxime; Cystitis; Drug Evaluation; Escherichia coli; Female; Humans; Klebsiella; Male; Middle Aged; Prostatic Diseases; Proteus; Providencia; Pseudomonas; Pyelonephritis; Serratia; Urinary Tract Infections