cefoxitin and Abscess

Topics: Abdomen; Abdominal Injuries; Abscess; Amikacin; Animals; Bacterial Infections; Carbenicillin; Cefamandole; Cefoxitin; Chloramphenicol; Clindamycin; Clinical Trials as Topic; Humans; Metronidazole; Rats; Ticarcillin

A randomized, double-blind trial compared the clinical and bacteriologic efficacy of ampicillin/sulbactam (2 g/1 g) and cefoxitin (2 g) administered intravenously every 6 h to patients with (n=49) or without (n=47) histories of injection drug abuse who presented with cutaneous or other soft-tissue infections. Cure or improvement occurred in 89.8% of ampicillin/sulbactam-treated patients, compared with 93.6% of cefoxitin-treated patients. The median time to resolution of all symptoms was 10.5 days with ampicillin/sulbactam treatment and 15.5 days with cefoxitin treatment. Mixed aerobic-anaerobic infection was encountered frequently in both treatment groups. A significantly higher percentage of Streptococcus species was found in the major abscesses of the patients with histories of injection drug abuse, compared with those without such histories (37% vs. 19%, respectively; P=.0009). Overall, ampicillin/sulbactam eradicated pathogens from the major abscesses in 100% of patients, whereas the eradication rate with cefoxitin was 97.9%. The 2 drugs were well tolerated. Ampicillin/sulbactam and cefoxitin were equally effective for the empirical treatment of cutaneous or other soft-tissue infections in injection drug abusers and patients who did not inject drugs.

Topics: Abscess; Adult; Ampicillin; Bacteria; Bacterial Infections; Cefoxitin; Cephamycins; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Skin Diseases, Bacterial; Soft Tissue Infections; Substance Abuse, Intravenous; Sulbactam

The efficacy of cefoxitin, a perioperative parenteral antibiotic, combined with mechanical bowel preparation and oral antibiotics to prevent wound infections and other septic complications in patients undergoing elective colorectal operations, was examined in a prospective randomized study. All 197 patients who completed the study received mechanical bowel preparation and oral neomycin/erythromycin base. In addition a perioperative parenteral antibiotic was given in three divided doses to 101 patients. The other 96 patients received no parenteral antibiotics. The overall incidence of intra-abdominal septic complications was 7.3% (7 of 96) in the control group (no cefoxitin) and 5% (5 of 101) in the treatment group (cefoxitin). This difference was not statistically significant. The incidence of abdominal wound infection was 14.6% in the control group and 5% in the treatment group, a statistically significant difference (p = 0.02). The addition of perioperative parenteral cefoxitin greatly reduced the incidence of wound infections in patients undergoing elective colorectal operations who had been prepared with mechanical bowel cleansing and oral antimicrobial agents.

Topics: Abscess; Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Cefoxitin; Cellulitis; Colon; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Postoperative Complications; Premedication; Preoperative Care; Prospective Studies; Randomized Controlled Trials as Topic; Rectum; Surgical Wound Infection

In a prospective, block-randomized, multicenter study, the safety and efficacy of cefoxitin in preoperative prophylaxis were studied. 1735 patients undergoing appendectomy were evaluable, and half of these patients received 2 g of cefoxitin before undergoing operation. The patients were divided into three groups: patients with a normal appendix, patients with an acutely inflamed appendix, and patients with a gangrenous appendix. The study showed for each group a significant reduction of the incidence of wound infection in patients receiving prophylaxis. However, intra-abdominal abscess formation was not influenced by preoperative antibiotic prophylaxis. Consequently, routine preoperative prophylaxis is recommended before appendectomy.

Topics: Abdomen; Abscess; Acute Disease; Adult; Appendectomy; Appendicitis; Cefoxitin; Denmark; Female; Humans; Male; Multicenter Studies as Topic; Premedication; Prospective Studies; Random Allocation; Surgical Wound Infection

Two hundred and forty adults undergoing acute appendicectomy were randomised to receive either cefoxitin or ceftriaxone 1 g intravenously at induction of anaesthesia. Patients were monitored daily while in hospital, and at least 4 weeks after discharge for evidence of wound, urinary or lower respiratory tract infection. We evaluated 167 patients at follow up and found no significant difference in infection rates between the two antibiotic groups. Thirty-four had normal appendices and 1 of 16 (6.3%) given cefoxitin and 2 of 18 (11.1%) given ceftriaxone developed wound infections. Ninety-seven had acute appendicitis and 3 of 48 (6.3%) given cefoxitin and 3 of 49 (6.1%) given ceftriaxone developed infections including 2 wound infections in each group. Thirty-six had gangrenous perforated or abscessed appendices: 31 were given additional antibiotics postoperatively, and 4 of 18 (22.2%) in each prophylactic antibiotic group developed infections, including wound infection in 3 given cefoxitin and in 4 given ceftriaxone. None of the infections were serious. Sixty-one percent presented after discharge from hospital. The mean hospital stay was 4.6 days for each antibiotic group. Neither antibiotic caused adverse effects.

Topics: Abscess; Adolescent; Adult; Appendectomy; Appendicitis; Cefoxitin; Ceftriaxone; Humans; Intestinal Perforation; Middle Aged; Premedication; Random Allocation; Rupture, Spontaneous; Surgical Wound Infection

One hundred eighty-eight patients were enrolled in a multicenter, randomized clinical trial to compare the safety and effectiveness of 1 to 2 gm cefotetan every 12 hours with those of 1 to 2 gm cefoxitin every 6 hours in patients with intra-abdominal infections. Most of the infections were community acquired, were associated with gastrointestinal tract perforation, and were caused by both anaerobic and aerobic bacteria. The median duration of therapy was 6 days for each group. The clinical response rate for the 95 evaluable patients in the cefotetan group was 98%, and that for the 43 evaluable patients in the cefoxitin group was 95%. Bacteriologically, 97% of the 58 evaluable patients in the cefotetan group and 89% of the 27 evaluable patients in the cefoxitin group had a satisfactory or presumed satisfactory response; two patients in the cefotetan group and three in the cefoxitin group were considered bacteriologic failures. Cefotetan was as effective as cefoxitin in eradicating Bacteroides fragilis and other species of Bacteroides, Clostridium sp., and gram-negative bacilli. The incidence of treatment-related adverse reactions for cefotetan (27%) was not statistically different from that for cefoxitin (17%). No clinically significant differences were detected between the treatment groups in changes in the results of clinical laboratory tests performed before and after treatment; a decrease in hematocrit among the cefotetan group was statistically greater (p = 0.04) than that for the cefoxitin group, and a decrease in serum creatinine level for the cefoxitin group was greater than that for the cefotetan group (p = 0.02). Cefotetan may represent an effective, safe, and cost-saving alternative to cefoxitin for the prompt treatment of community-acquired intra-abdominal infections.

Topics: Abdomen; Abscess; Adult; Aged; Bacterial Infections; Cefotetan; Cefoxitin; Cephamycins; Clinical Trials as Topic; Female; Gastrointestinal Diseases; Humans; Male; Middle Aged; Peritonitis; Random Allocation

To compare the effectiveness of cefotetan administered at 2 g once a day with cefoxitin at 1 or 2 g three times a day in the treatment of hospitalized patients with skin and superficial soft tissue infections, 194 patients from eight centers were enrolled in an open, randomized trial. Most of the 104 evaluable patients in the cefotetan group and 50 in the cefoxitin group were young men with community-acquired, moderate or severe cellulitis, or abscesses of the upper and lower extremities caused by Staphylococcus aureus, Streptococcus species, Escherichia coli, Proteus mirabilis, Bacteroides fragilis and other species of bacteroides, peptococcus species, and peptostreptococcus species. The mean duration of treatment was 7.5 days for cefotetan and 7.1 days for cefoxitin. A successful clinical response was achieved in 97 percent of the cefotetan patients and in 94 percent of the cefoxitin patients. Of the 88 and 39 bacteriologically evaluable patients in the cefotetan and cefoxitin groups, respectively, a satisfactory bacteriologic response occurred in 96 percent and 87 percent of the patients. No clinically significant changes in clinical laboratory determinations were noted. The incidence of adverse reactions in the cefotetan group (17 percent) was significantly different from that for the cefoxitin group (6 percent) (p less than 0.05); however, the incidence of treatment-related reactions was not significant and the events were mild. Discontinuation of therapy was necessary only in two patients in whom allergic-type reactions developed. A once-daily regimen of cefotetan was as effective as thrice-daily cefoxitin in this study in the treatment of primarily polymicrobial, moderate, or severe infections of the skin and superficial soft tissue.

Topics: Abscess; Adult; Cefotetan; Cefoxitin; Cellulitis; Cephamycins; Clinical Trials as Topic; Female; Humans; Male; Random Allocation; Skin Diseases, Infectious

A randomized, double-blind comparative trial of cefoxitine and piperacillin was conducted in two groups of 30 patients with a similar number of the usual risk factors. Doses of cefoxitine 2 g and piperacillin 4 g were administered only once, except in some cases when the operation lasted more than 5 hours. Analysis of the results showed that the two antibiotics had equivalent prophylactic effectiveness (congruent to 6%) in colorectal surgery.

Topics: Abscess; Cefoxitin; Colon; Double-Blind Method; Female; Humans; Male; Piperacillin; Postoperative Complications; Premedication; Random Allocation; Rectum

Postoperative infection accounts for significant morbidity and mortality following penetrating abdominal trauma. During a 2 1/2-year period, December 1980 through June 1983, 257 patients sustaining penetrating abdominal injury were initially treated at Parkland Memorial Hospital in Dallas. Following the patient's written consent, they were prospectively randomized to receive, prior to surgery, intravenous clindamycin 600 mg every 6 hours and tobramycin 1.2 mg/kg every 6 hours (CT), or cefamandole 1 gm every 4 hours (M), or cefoxitin 1 gm every 4 hours (C). The antibiotics were continued for 48 hours. Major organ injuries in the three groups were comparable. The overall infection rate was significantly less in the cefoxitin group (13%), compared to cefamandole at 29%, and was comparable to the combination of clindamycin/tobramycin at 20%. The most significant difference followed colon injury. There were 96 patients who sustained colon injuries and the infection rate was CT 33%, M 62%, and C 19% (p = 0.002). If nonoperative wound infections were excluded from the colon group and only severe infections were evaluated, the infection rate was CT 18%, M 38%, and C 13% (p = 0.021). The infection rate was higher in the shock patients and tended to increase as age increased. Enterococcus, Escherichia coli, and Klebsiella pneumoniae were the most frequent aerobes isolated along with anaerobes. Five of six Bacteroides isolates from major infections occurred in the cefamandole group; two of which were in bacteremic patients. The hospital stay corresponded with infection rates, being 11.4 days (CT), 13.1 days (M), and 9.4 days (C). The results of this study indicate that cefoxitin is comparable to the combination of clindamycin/tobramycin and superior to cefamandole when used before surgery in patients sustaining penetrating abdominal trauma. The study suggests that antibiotic coverage should be against aerobes and anaerobes. Routine administration of an aminoglycoside is unnecessary.

Topics: Abdominal Injuries; Abscess; Adolescent; Adult; Aged; Aminoglycosides; Anti-Bacterial Agents; Cefamandole; Cefoxitin; Clindamycin; Colostomy; Drug Therapy, Combination; Humans; Ileostomy; Middle Aged; Premedication; Prospective Studies; Random Allocation; Tobramycin; Wound Infection; Wounds, Gunshot; Wounds, Stab

From 1979 through 1981, 152 patients with penetrating injuries of the intra-abdominal gastrointestinal tract were placed on one of three different perioperative antibiotic regimens in a prospective randomized fashion. The three regimens were A) cefamandole 2 grams every 4 hours, B) cefoxitin 2 grams every 6 hours, and C) ticarcillin 3 grams every 4 hours and tobramycin 1.5 mg/kg every 8 hours. Antibiotics were administered intravenously before and for 48 hours following surgical exploration and repair. The three treatment groups were similar with respect to age, average number of organ injuries, and distribution of organ injuries. Cefoxitin-treated patients experienced uneventful recoveries more often than cefamandole-treated patients (94% vs. 80.3%, p less than 0.05) when the incidence of gram-negative wound infection and intra-abdominal abscess formation was considered, while the number of patients who experienced uneventful recoveries in the ticarcillin-tobramycin group was not statistically different from the other two groups of patients. Bacteroides fragilis was isolated from three of the six abscesses occurring in the cefamandole-treated group, while no anaerobes were isolated from abscesses in patients treated with either of the other two regimens. The results of this study suggest that the most effective perioperative antibiotic regimen for patients with penetrating gastrointestinal wounds should possess activity against both aerobic and anaerobic flora of the bowel.

Topics: Abdomen; Abdominal Injuries; Abscess; Adult; Anti-Bacterial Agents; Cefamandole; Cefoxitin; Clinical Trials as Topic; Female; Humans; Male; Postoperative Complications; Premedication; Prospective Studies; Random Allocation; Surgical Wound Infection; Ticarcillin; Tobramycin; Wounds, Penetrating

A prospective controlled randomized-block multicenter study was carried out in 209 patients undergoing surgery for perforated or ruptured appendicitis. The patients received either cefoxitin or ampicillin + metronidazole for 5 days. The treatment was started peroperatively. In both groups wound infections were found to be less than 10 per cent and no difference could be demonstrated. However cefoxitin was significantly superior to ampicillin + metronidazole in preventing intra-abdominal abscesses (P less than 0.05). Cefoxitin offers a single drug treatment that adequately reduces postoperative infectious complications in patients undergoing surgery for perforated or ruptured appendicitis.

Topics: Abdomen; Abscess; Adolescent; Adult; Aged; Ampicillin; Appendectomy; Appendicitis; Cefoxitin; Child; Child, Preschool; Drug Therapy, Combination; Female; Humans; Male; Metronidazole; Middle Aged; Prospective Studies; Rupture, Spontaneous; Surgical Wound Infection

The therapeutic efficacy of cefoxitin was studied in 15 patients with pulmonary or urinary infections, after other unsuccessful antibiotic treatment. The drug determined a total regression of clinical picture within 10 days of therapy. Our results show that brief periods of treatment are sufficient in order to obtain recovery and to avoid selection of resistant germs. Patients treated with cefoxitin did not present any intolerance. The conclusion is drawn that "Mefoxin" is useful in patients affected by infections resistant to common antibiotics.

Topics: Abscess; Adult; Aged; Bronchitis; Bronchopneumonia; Buttocks; Cefoxitin; Clinical Trials as Topic; Drug Tolerance; Female; Humans; Klebsiella; Male; Middle Aged; Pyelitis; Streptococcus

Topics: Abdomen; Abdominal Injuries; Abscess; Amikacin; Animals; Bacterial Infections; Carbenicillin; Cefamandole; Cefoxitin; Chloramphenicol; Clindamycin; Clinical Trials as Topic; Humans; Metronidazole; Rats; Ticarcillin

The oxacillin- and cefoxitin-susceptible

Topics: Abscess; Anti-Bacterial Agents; Bacterial Proteins; Cefoxitin; Female; Genomics; Humans; Lactation; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Oxacillin; Penicillin-Binding Proteins; Staphylococcal Infections; Staphylococcus aureus

The treatment of seminal vesicle abscesses (SVA) by transrectal ultrasound-guided transrectal and transperineal approaches were evaluated in this study.. Six SVA cases were diagnosed among 2350 patients admitted to our ultrasound unit with prostate and seminal vesicle symptoms during the last 6 years. Four out of six cases had bilateral, and two had unilateral SVA. Transperineal puncture and aspiration was done in four patients with bilateral abscesses and transrectal approach was preferred in two patients with unilateral abscesses.. For both approaches, the aspiration was successfully done without any complication. The mean durations of intervention were 64 and 13 min, and the durations of hospitalization were 2 and 3 days for the transperineal and transrectal approaches, respectively.. Transrectal ultrasound examination allows simultaneous evaluation of the gland and the guidance for a needle puncture and aspiration. Furthermore, rapid pain relief, regression of other symptoms, minimally invasive technique and shorter hospitalization seem to be important features as compared with conservative and surgical treatment modalities.

Topics: Abscess; Adolescent; Adult; Anti-Bacterial Agents; Cefoxitin; Escherichia coli Infections; Follow-Up Studies; Genital Diseases, Male; Hospitalization; Humans; Male; Middle Aged; Minimally Invasive Surgical Procedures; Needles; Paracentesis; Perineum; Rectum; Seminal Vesicles; Suction; Time Factors; Ultrasonography, Interventional

Regional digital i.v. perfusion was used to treat a severe sole abscess associated with a wire foreign body in a 19-yr-old female Asian elephant (Elephas maximus) housed at the Paris Zoo. The cow presented with acute right forelimb lameness and swelling that persisted despite 4 days of anti-inflammatory therapy. Under anesthesia, a 10- x 0.5- x 0.5-cm wire was extracted from the sole of the right foot. There was a 2-cm-deep, 7-cm-diameter abscess pocket that was subsequently debrided. Regional digital i.v. perfusion was performed and repeated 15 days later, using cefoxitin and gentamicin on both occasions. Between treatments, the cow received trimethoprim-sulfamethoxazole and phenylbutazone orally. Within 2 days of administering anesthesia and the first perfusion treatment, the lameness improved dramatically. When phenylbutazone was discontinued 1 wk after the first treatment, the lameness had completely resolved. At the second treatment, there was no evidence of further soft tissue infection, and the abscess pocket had resolved.

Topics: Abscess; Animals; Animals, Zoo; Anti-Bacterial Agents; Cefoxitin; Debridement; Elephants; Female; Foreign Bodies; Gentamicins; Hoof and Claw; Lameness, Animal; Perfusion; Treatment Outcome

Topics: Abscess; Ampicillin; Animals; Anti-Bacterial Agents; Bacteroides fragilis; Bacteroides Infections; Cefotetan; Cefoxitin; Cephamycins; Drug Therapy, Combination; Escherichia coli; Escherichia coli Infections; Male; Mice; Mice, Inbred C3H; Microbial Sensitivity Tests; Penicillins; Peritoneal Diseases; Sulbactam

The recovery of Candida albicans along with bacteria from the abdomen in the setting of peritonitis is becoming increasingly common. It is not known whether the interactions between the fungal and bacterial elements of these infections are synergistic, competitive, or neutral. To study this question, we have examined the effects of both the addition of C. albicans to a solely bacterial infection caused by Escherichia coli and Bacteroides fragilis, and the deletion of various components of this system using directed antimicrobial therapy. In a mixed infection, both C. albicans and bacteria contributed to mortality, since only the combination of cefoxitin and amphotericin B improved survival (from 50% to 90%). The addition of C. albicans to the bacterial inoculum increased the recovery of abscesses, but only to the number seen with fungal infection alone, implying two fairly independent processes. Although the number of bacteria recovered from abscesses at 10 days postinfection was unchanged with the addition of fungi, the deletion of the bacterial component of mixed infections led to the overgrowth of C. albicans. We conclude that this model of mixed C. albicans/E. coli/B. fragilis peritonitis is best characterized as two nonsynergistic, parallel infections with incomplete competition, allowing the survival of all three organisms to eventual abscess formation.

Topics: Abscess; Amphotericin B; Animals; Bacteroides fragilis; Bacteroides Infections; Candida albicans; Candidiasis; Cefotetan; Cefoxitin; Clindamycin; Colony Count, Microbial; Drug Combinations; Escherichia coli; Escherichia coli Infections; Male; Mice; Mice, Inbred BALB C; Peritoneal Diseases; Peritonitis; Survival Rate

A 14-year-old girl had progressive dyspnea and right lower chest pain for about 1 1/2 months and a weight loss of 3 kg in 2 months. Chest X-ray revealed right pleural effusion and a round infiltration over the right lower chest, initially suspected to be malignant. Image study revealed consolidation in the right middle and lower lobes with abscess-like lesions around the right lower pleura and transdiaphrenic involvement to the subphrenic region. The lesion had also invaded the intercostal muscle. The pleural abscess was obtained by fiberoptic thoracoscopy, and culture of the pus grew typical colonies of Actinobacillus actinomycetemcomitans. After the causative microorganism had been identified, cefoxitin was given for 2 weeks followed by oral amoxicillin (250 mg/6 h) for a total period of 3 months. Follow-up chest X-ray revealed resolution of the lung lesions and the patient recovered gradually without any sequelae.

Topics: Abscess; Actinobacillus Infections; Adolescent; Aggregatibacter actinomycetemcomitans; Amoxicillin; Cefoxitin; Cephamycins; Female; Humans; Penicillins; Pneumonia, Bacterial; Radiography, Thoracic; Subphrenic Abscess; Thoracic Diseases

Topics: Abdomen; Abscess; Animals; Bacterial Infections; Bacteroides fragilis; Bacteroides Infections; Cefmetazole; Cefotetan; Cefoxitin; Drug Evaluation, Preclinical; Escherichia coli Infections; Male; Mice

Cefoxitin, cefotetan, and cefmetazole were compared in 10-day therapy of intra-abdominal and subcutaneous infections caused by three organisms: Bacteroides fragilis and Bacteroides thetaiotaomicron combined with either Escherichia coli or Staphylococcus aureus. Intra-abdominal infection was caused by B. fragilis plus B. thetaiotaomicron plus E. coli. Therapy was initiated immediately before inoculation or was delayed for 8 h. Mortality was 14 of 30 (47%) for saline-treated mice, and all survivors developed abscesses. Immediate therapy reduced mortality and the percentage of mice with abscesses (in survivors), respectively, to 17 and 20% with cefoxitin, 0 and 13% with cefotetan, and 0 and 17% with cefmetazole, and the numbers of all bacteria were reduced by all the cephalosporins. Delayed therapy reduced mortality and abscess formation, respectively, to 20 and 8% of mice with cefoxitin, 10 and 93% with cefotetan, and 7 and 96% with cefmetazole. B. thetaiotaomicron survived in all abscesses treated with cefotetan and cefmetazole. Subcutaneous abscesses were caused by each organism alone or in combinations of one aerobe (S. aureus or E. coli) and one or two Bacteroides species. Early therapy reduced the numbers of all bacteria independent of their in vitro susceptibility. All agents reduced the number of each Bacteroides species with either E. coli or S. aureus. However, when therapy was delayed, cefotetan and cefmetazole were less effective than cefoxitin against B. thetaiotaomicron. Cefotetan was the most active agent against E. coli, and cefmetazole was the most effective against S. aureus. These data illustrate the efficacy of all tested cephalosporins in the prophylaxis of polymicrobial infections.

Topics: Abdomen; Abscess; Animals; Bacterial Infections; Bacteroides fragilis; Bacteroides Infections; Cefmetazole; Cefotetan; Cefoxitin; Disease Models, Animal; Escherichia coli; Escherichia coli Infections; Male; Mice; Microbial Sensitivity Tests; Skin Diseases, Bacterial; Staphylococcal Infections; Staphylococcal Skin Infections; Staphylococcus aureus

We examined the efficacy of ampicillin-sulbactam (2:1) and cefoxitin in the treatment of infections caused by Escherichia coli strains exhibiting increasing levels of beta-lactamase-mediated resistance to ampicillin-sulbactam in the rat intra-abdominal abscess model. Cefoxitin was superior to ampicillin-sulbactam in the treatment of infections caused by all strains. Treatment with ampicillin-sulbactam resulted in a statistically significant decrease in CFU per gram of abscess in comparison with treatment with ampicillin alone for both the moderately resistant and the resistant strains, with an inverse correlation between the MIC and the absolute decrease in CFU per gram of abscess.

Topics: Abdomen; Abscess; Ampicillin; Animals; Cefoxitin; Colony Count, Microbial; Drug Therapy, Combination; Escherichia coli Infections; Male; Microbial Sensitivity Tests; Rats; Rats, Sprague-Dawley; Sulbactam

Hemorrhagic shock has been shown to increase the susceptibility to infection despite the administration of conventionally accepted doses of antimicrobial drugs. The efficacy of increasing antibiotic dose in a model of mixed gram-negative infection, both with and without hemorrhagic shock, was examined. Shock was induced by bleeding rats to a mean arterial pressure of 45 millimeters of mercury for 45 minutes followed by resuscitation with shed blood and saline solution. One hour after shock or sham, the rats were inoculated with 1 x 10(8) Escherichia coli plus 1 x 10(9) Bacteroides fragilis in a fecal suspension subcutaneously. Rats were given either no antibiotic (CONTROL) or cefoxitin at 30 milligrams per kilogram (STANDARD) or 200 milligrams per kilogram (HIGH) intraperitoneally, 30 minutes before and at six and 12 hours after inoculation. Tissue cefoxitin concentrations were measured 30 minutes before and at six and 12 hours after inoculation. Tissue cefoxitin concentrations were measured 30 minutes after the initial dose. STANDARD reduced abscess diameter by 58 percent compared with CONTROL in rats that were not shocked, but only by 26 percent after shock (p < 0.05 shock versus sham). HIGH further decreased abscess diameter and weight (4 +/- 1 millimeter and 22 +/- 22 milligrams) after shock compared with STANDARD (9 +/- 1 millimeter and 230 +/- 90 milligrams; both p < 0.05). Peak tissue cefoxitin levels were greater than 19 times the minimal inhibitory concentration for each bacteria for HIGH compared with eight times for STANDARD. These data demonstrate that an increased dose of cefoxitin was superior to a conventional dose in controlling a mixed gram-negative infection after shock and suggest that altering traditional antibiotic use may decrease the incidence of infection after shock and hemorrhage.

Topics: Abscess; Animals; Bacteroides fragilis; Bacteroides Infections; Cefoxitin; Disease Susceptibility; Escherichia coli Infections; Female; Rats; Rats, Sprague-Dawley; Shock, Hemorrhagic; Wound Infection

Shock increases the propensity to develop infection after injury or operation. This study evaluated the effect of cefoxitin, interferon gamma (INF-gamma), and tumor necrosis factor alpha (TNF-alpha) on the development of a polymicrobial soft-tissue infection. After sham operation or hemorrhagic shock and resuscitation, Sprague-Dawley rats were inoculated with 1 x 10(8) Escherichia coli and 1 x 10(9) Bacteroides fragilis in a 5% fecal suspension. Animals received either no treatment, cefoxitin, recombinant rat INF-gamma, recombinant human TNF-alpha, or cefoxitin/cytokine combinations. Cefoxitin reduced abscess size by 57% in animals without shock but only by 26% after shock. Although neither INF-gamma nor TNF-alpha alone had a salutary effect when given with cefoxitin in animals after shock, INF-gamma and TNF-alpha reduced abscess size by 50% and 55%, respectively. These results suggest that INF-gamma and TNF-alpha may be useful to reduce the severity of mixed gram-negative infections after shock with bacterial contamination.

Topics: Abscess; Animals; Cefoxitin; Escherichia coli Infections; Female; Interferon-gamma; Rats; Rats, Inbred Strains; Recombinant Proteins; Shock; Tumor Necrosis Factor-alpha

Mycobacterium fortuitum is an environmental organism which rarely causes disease. We report the case of a young man in whom this organism caused a soft tissue abscess. The laboratory findings and subsequent management of the case are described.

Topics: Abscess; Adult; Cefoxitin; Ciprofloxacin; Connective Tissue Diseases; Humans; Male; Mycobacterium Infections

Cefamandole, cefoxitin, cefotetan, ceftizoxime, imipenem plus cilastatin, and ampicillin plus sulbactam were compared in the eradication of subcutaneous abscess in mice caused by Bacteroides fragilis group organisms and Escherichia coli alone or in combination. The abscesses were examined 5 d after inoculation. B. fragilis group reached log10.1-11.0 organisms per abscess and E. coli log11.6-12.5. Imipenem plus cilastatin significantly reduced (in 6.9-10.6 logs) the number of E. coli and all members of B. fragilis group alone or in all combinations. Ampicillin plus sulbactam reduced the numbers of all B. fragilis group (in 4.2-7.2 logs) but was less effective against E. coli (reduction of 1.8-4.2 logs). Cefoxitin was effective in significantly reducing (in 4.9-6.2 logs) the number of E. coli and all members of B. fragilis group alone or in all combinations. Cefotetan was effective against B. fragilis (reduction of 5.1-6.6 logs) and E. coli alone or in combination but did not reduce the number of Bacteroides thetaiotaomicron, Bacteroides vulgatus, and Bacteroides ovatus. Ceftizoxime was effective against only B. ovatus (reduction of 3.7-5.8) and E. coli (reduction of 6.0-8.1 logs); it did not reduce the number of other organisms. Cefamandole was effective against only E. coli and was not effective against any member of the B. fragilis group. These in vivo data confirm the in vitro activity of these antimicrobials.

Topics: Abscess; Ampicillin; Animals; Anti-Bacterial Agents; Bacteroides fragilis; Bacteroides Infections; Cefamandole; Cefotetan; Cefoxitin; Ceftizoxime; Cilastatin; Cilastatin, Imipenem Drug Combination; Disease Models, Animal; Drug Combinations; Drug Therapy, Combination; Escherichia coli; Escherichia coli Infections; Imipenem; Male; Mice; Skin Diseases; Sulbactam

The relationships between capsulate and non-capsulate Bacteroides fragilis strains and Escherichia coli, and between capsulate and non-capsulate strains of the B. melaninogenicus group and Streptococcus pyogenes, were studied in a subcutaneous abscess model in mice. Selective antimicrobial agents directed against either aerobic or anaerobic bacteria were used alone or in combination to explore the effect of eradication of one component of the mixed infection. Single agent therapy effective against both aerobic and anaerobic flora was also employed. Single therapy of mixed infection directed at the elimination of only one organism (S. pyogenes, E. coli or Bacteroides sp.) caused significant reductions in the numbers of sensitive organisms and also smaller yet significant decreases in the numbers of insensitive organisms. However, the abscesses were not eliminated after such therapy. Combination therapy or use of a single agent (cefoxitin) directed against the aerobic and anaerobic components of the infection was more effective. Non-capsulate Bacteroides spp. became capsulate after passage in mice mixed with either S. pyogenes or E. coli. Therapy directed at the elimination of S. pyogenes and E. coli did not prevent the emergence of capsulate Bacteroides spp. These data demonstrate the synergy between all members of the B. fragilis group and E. coli and between the B. melaninogenicus group and S. pyogenes, and reiterate the need to direct antimicrobial therapy at the eradication of the aerobic and anaerobic components of mixed infections.

Topics: Abscess; Aerobiosis; Anaerobiosis; Animals; Bacteroides; Bacteroides fragilis; Bacteroides Infections; Cefoxitin; Disease Models, Animal; Drug Resistance, Microbial; Drug Therapy, Combination; Escherichia coli; Escherichia coli Infections; Gentamicins; Leucomycins; Male; Metronidazole; Mice; Microbial Sensitivity Tests; Prevotella melaninogenica; Skin Diseases; Streptococcal Infections; Streptococcus pyogenes

The third day temperature is frequently used in the decision whether to continue or terminate antibiotic treatment following appendicectomy in perforated appendicitis. To assess the value of the third day temperature in predicting intraperitoneal infectious complications we studied 235 consecutive patients treated with a 3-day course of cefoxitin after surgery for perforated appendicitis. The results demonstrated that regardless of the level of elevated temperature chosen, the predictive value ranged between 16 and 33%. In consequence, elevated third day temperature per se does not provide any rational basis for continuing antibiotic treatment in order to prevent intraperitoneal infectious complications following appendectomy in perforated appendicitis.

Topics: Abdomen; Abscess; Adolescent; Adult; Aged; Aged, 80 and over; Appendectomy; Appendicitis; Body Temperature; Cefoxitin; Child; Child, Preschool; Drug Administration Schedule; Female; Humans; Intestinal Perforation; Male; Middle Aged; Postoperative Complications; Surgical Wound Infection; Time Factors

Topics: Abscess; Bacteroides fragilis; Bacteroides Infections; Cefoxitin; Female; Humans; Infant

We inoculated 120 rats with 2 X 10(9) Escherichia coli or 2 X 10(9) Bacteroides fragilis suspended in normal saline solution or incorporated into fibrin clots. In the control group, all animals died after inoculation with E coli, but none died after the inoculation with B fragilis; both were suspended in normal saline solution. Escherichia coli entrapped in fibrin did not cause mortality but did result in abscess formation in all animals. Bacteroides fragilis incorporated into fibrin clots resulted in abscess formation in the majority of animals. Treatment with gentamicin sulfate, ampicillin sulfate, and cefoxitin sodium completely abolished the mortality secondary to E coli suspended in normal saline solution but did not influence the rate of abscess formation secondary to E coli incorporated into fibrin clots. Similarly, cefoxitin and clindamycin phosphate did not significantly change abscess formation secondary to B fragilis incorporated into fibrin clots. We conclude that systemic antibiotics are ineffective in the prevention of abscesses secondary to bacteria trapped in fibrin, either because they do not reach bactericidal levels in the fibrin clot, as in the case of gentamicin, ampicillin, and clindamycin, or, as in the case of cefoxitin, because of the inoculum effect caused by the high number of bacteria. Fibrinogen or fibrin itself do not afford any protection of bacteria against the action of antibiotics.

Topics: Abscess; Ampicillin; Animals; Anti-Bacterial Agents; Ascites; Bacteroides fragilis; Bacteroides Infections; Blood Coagulation; Cefoxitin; Clindamycin; Escherichia coli; Escherichia coli Infections; Fibrin; Gentamicins; Male; Rats; Rats, Inbred Strains

This study was undertaken to assess the efficacy and safety of a 3-day course of treatment with Mefoxitin (cefoxitin sodium, MSD) in patients with perforated or ruptured appendicitis. A series of 235 patients undergoing surgery for perforated or ruptured appendicitis were treated with cefoxitin for 3 days. Twenty-four patients (10%) developed wound infection and 28 (12%) developed an intra-abdominal abscess postoperatively. No side effects were observed during the study. Compared with the results of our previous series, where a 5-day course of cefoxitin was used, the incidence of wound infection was similar. However the incidence of intra-abdominal abscesses in the present series was significantly higher (p less than 0.01). The results seem to indicate that a 3-day course of cefoxitin is as effective as a 5-day course in controlling the incidence of wound infection following surgery for perforated or ruptured appendicitis, whereas the 3-day course seems to be inferior to a 5-day course in controlling the incidence of intra-abdominal abscesses.

Topics: Abscess; Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Appendicitis; Cefoxitin; Child; Child, Preschool; Female; Humans; Intestinal Perforation; Male; Middle Aged; Rupture, Spontaneous; Surgical Wound Infection

Topics: Abdomen; Abscess; Adult; Appendectomy; Appendicitis; Bacteroides fragilis; Bacteroides Infections; Cefoxitin; Diagnosis, Differential; Humans; Male; Pain

A psoas muscle abscess due to Yersinia enterocolitica developed in a 71-year-old man with mild type II diabetes mellitus. There was no evidence of gastrointestinal infection or septicemia, and treatment with computed tomography-directed percutaneous drainage and cefoxitin resulted in cure. This represents the first known reported case of psoas abscess due to Y. enterocolitica.

Topics: Abscess; Aged; Cefoxitin; Humans; Male; Muscular Diseases; Yersinia enterocolitica; Yersinia Infections

Strains of Bacteroides fragilis group isolated from peritoneal pus were tested for susceptibility to cefalotin, cefamandole, cefoxitin, clindamycin and metronidazole. Clindamycin and metronidazole were found to display the lowest MIC and MBC values. The median serum level of these antimicrobials was 2-4 times as high as the MIC effective against 100% of strains. The most active cephalosporin was the cephamycin derivative cefoxitin that inhibited 98% of strains at 16 mg/l which corresponds with the usual median serum level achieved at commonly recommended treatment regimens. The MICs of 16 mg/l to cefalotin and cefamandole were found in 9.8% and 3.7% of strains, respectively. These findings are consistent with data reported in the literature. Attention is also centered on the mode of antimicrobial action, principles of bacterial resistance and on factors which are co-responsible for the therapeutic effectiveness of the antimicrobials studied.

Topics: Abscess; Bacteroides; Bacteroides Infections; beta-Lactamases; Cefamandole; Cefoxitin; Cephalosporins; Cephalothin; Clindamycin; Humans; Metronidazole; Peritoneal Diseases

Lethal fecal peritonitis was created in 253 rats. The rats were then randomized to receive injections of saline solution or clindamycin and gentamicin. All rats received a saline solution lavage and were then further divided to receive a lavage with saline solution, gentamicin, clindamycin or cefoxitin. At the end of nine days, all surviving rats were sacrificed and examined for abscesses. All groups receiving clindamycin and gentamicin parenterally as well as those receiving a lavage with gentamicin or cefoxitin had a significantly better survival rate than did the control group. There was no difference in the number of abscesses in any group receiving antibiotics. Therefore, in this study, no benefit was achieved from an antibiotic lavage in rats receiving effective parenteral therapy.

Topics: Abscess; Animals; Cefoxitin; Clindamycin; Feces; Gentamicins; Peritoneal Diseases; Peritonitis; Random Allocation; Rats; Rats, Inbred Strains; Therapeutic Irrigation

The pharmacokinetic properties of 10 antimicrobial agents were examined in sterile and infected encapsulated subcutaneous abscesses in mice. The inoculum for sterile abscesses was autoclaved cecal contents; that for infected abscesses was autoclaved cecal contents combined with Bacteroides fragilis. The antimicrobial agents examined were rosaramicin, clindamycin, chloramphenicol, metronidazole, and six beta-lactam antibiotics. All antimicrobial agents entered abscesses, produced peak levels of biological activity that were somewhat delayed in comparison to serum levels, and were present in negligible levels 8 hr after administration. The highest concentration in abscesses was achieved with rosaramicin and clindamycin, with peak levels of 43%--63% of the peak serum level. Peak levels of other antimicrobial agents in sterile abscesses were 13%--27% of the peak serum level. Levels of biologically active during were significantly lower in infected abscesses than in sterile abscesses for antimicrobial agents that are inactivated by B. fragilis beta-lactamase.

Topics: Abscess; Animals; Bacteroides fragilis; Cefamandole; Cefoperazone; Cefoxitin; Cephalosporins; Cephalothin; Chloramphenicol; Clindamycin; Dose-Response Relationship, Drug; Lactams; Male; Mice; Mice, Inbred C57BL; Microbial Sensitivity Tests; Skin

Topics: Abscess; Cefoxitin; Drug Resistance, Microbial; Gastroenteritis; Gram-Negative Aerobic Bacteria; Gram-Negative Anaerobic Bacteria; Humans; Prospective Studies

Topics: Abortion, Septic; Abscess; Anaerobiosis; Azlocillin; Bacterial Infections; Cefoxitin; Cefuroxime; Cesarean Section; Debridement; Female; Genital Diseases, Female; Humans; Metronidazole; Penicillins; Pregnancy; Surgical Wound Infection

30 patients were treated with i.v. cefoxitin (4-8 g/day), of which 20 had documented infections which included endocarditis (5), lung abscess (4), empyema (4), liver and subhepatic abscess (3), osteomyelitis (3), and pancreatic abscess (1). 14 patients had infections caused by anaerobic bacteria and 5 had endocarditis due to aerobic organisms. All but 2 patients with osteomyelitis of the mandible were cured. Adverse reactions were noted in 7 patients, mostly due to drug fever and leukocytosis; one had Coombs'-positive hemolytic anemia. The average serum cefoxitin levels were 24, 16, 12, and 4 microgram/ml at 1, 2, 3 and 4 h, respectively, and the average serum/pleural fluid ratio was 1:0.5 +/- 0.25. All anaerobic and aerobic isolates except one strain of Bacteroides fragilis were susceptible to cefoxitin at less than or equal to 32 microgram/ml. The concentration of cefoxitin in the tissues was measured in 8 rabbits; it was 4 +/- 1 microgram/ml in the heart and 2 +/- 0.5 microgram/ml in the femur and mandibular tissue, suggesting that the lack of response in cases of osteomyelitis could be due to inadequate antibiotic concentration in the bone. Our study suggests that cefoxitin can be used in the treatment of anaerobic infections and endocarditis due to susceptible organisms.

Topics: Abscess; Adult; Animals; Bacterial Infections; Bacteriological Techniques; Cefoxitin; Cephalosporins; Drug Evaluation; Empyema; Endocarditis, Bacterial; Female; Humans; Liver Abscess; Lung Abscess; Male; Osteomyelitis; Pancreatitis; Rabbits; Tissue Distribution

Cefoxitin (mefoxin), a new semisynthetic cephamycin antibiotic, resistant to degradation by beta-lactamase enzymes produced by bacteria. In vitro, cefoxitin is active against virtually all clinically important gram-negative facultative bacteria other than Pseudomonas and Enterobacter spp., gram-positive aerobic bacteria other than the enterococcus, and clinically important anaerobic organisms, including Bacteroides fragilis. This broad antibacterial spectrum suggested that cefoxitin might be an effective single antibiotic agent for the treatment of mixed aerobic-anaerobic infections in obstetric and gynecologic patients. In this investigation, the efficacy and safety of cefoxitin was evaluated in 109 patients--68 with salpingitis, 25 with endomyometritis, 9 with pelvic cellulitis, and 7 with pelvic abscesses. An average of 2.5 bacteria were isolated from each patient. Aerobic bacteria alone was isolated in 38% of patients, anaerobic bacteria alone in 25%, and a combination of aerobic and anaerobic bacteria was isolated in 37% of patients. Overall, 100 of 109 (92%) infections responded to treatment with cefoxitin alone. The major cause of treatment failure was the presence of abscesses requiring surgical drainage. In addition to being an effective single agent for the management of pelvic infections, cefoxitin proved to be safe and well tolerated by patients.

Topics: Abscess; Acute Disease; Adolescent; Adult; Aerobiosis; Anaerobiosis; Bacterial Infections; Bacteroides Infections; Cefoxitin; Cellulitis; Cephalosporins; Female; Gonorrhea; Humans; Middle Aged; Pelvis; Salpingitis