cefoxitin and Bacterial-Infections

Anaerobes are the most predominant components of the normal human skin and mucous membranes bacterial flora, and are a frequent cause of endogenous bacterial infections. Anaerobic infections can occur in all body locations: the central nervous system, oral cavity, head and neck, chest, abdomen, pelvis, skin, and soft tissues. Treatment of anaerobic infection is complicated by their slow growth in culture, by their polymicrobial nature and by their growing resistance to antimicrobials. Antimicrobial therapy is frequently the only form of therapy needed, whereas in others it is an important adjunct to drainage and surgery. Because anaerobes generally are isolated mixed with aerobes, the antimicrobial chosen should provide for adequate coverage of both. The most effective antimicrobials against anaerobes are: metronidazole, the carbapenems (imipenem, meropenem, doripenem, ertapenem), chloramphenicol, the combinations of a penicillin and a beta-lactamase inhibitors (ampicillin or ticarcillin plus clavulanate, amoxicillin plus sulbactam, piperacillin plus tazobactam), tigecycline, cefoxitin and clindamycin.

Topics: Anti-Infective Agents; Bacteria, Anaerobic; Bacterial Infections; beta-Lactamase Inhibitors; Carbapenems; Cefoxitin; Chloramphenicol; Clindamycin; Drug Resistance, Bacterial; Humans; Metronidazole; Minocycline; Penicillins; Tigecycline

Topics: Anti-Bacterial Agents; Bacterial Infections; beta-Lactamases; Cefoxitin; Drug Resistance, Bacterial; Humans; International Cooperation; Macrolides; Methicillin Resistance; Microbial Sensitivity Tests; Staphylococcus aureus; Vancomycin Resistance

Cefoxitin is a second generation cephalosporin commonly used to treat anaerobic and mixed infections. The authors reviewed the recently published data about the efficacy of cefoxitin; its utility in different clinical entities, patterns of resistance and resistance mechanisms, indications and reliability of in vitro susceptibility testing. These data indicate the need for determining susceptibility patterns of anaerobics at each hospital and point out to the essential close communication between the microbiologist and clinician to the rational treatment of anaerobic infections.

Topics: Bacteria, Anaerobic; Bacterial Infections; Cefoxitin; Drug Resistance, Microbial; Humans; Microbial Sensitivity Tests

Topics: Bacterial Infections; Cefazolin; Cefoxitin; Cefuroxime; Cephalexin; Cephalosporins; Drug Costs; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Humans

Topics: Bacterial Infections; Bacteroides Infections; Cefamandole; Cefazolin; Cefonicid; Cefoxitin; Cefuroxime; Cephalosporins; Gonorrhea; Haemophilus Infections; Humans; Respiratory Tract Infections; Structure-Activity Relationship

Topics: Anti-Bacterial Agents; Bacteria, Anaerobic; Bacterial Infections; Cefoxitin; Child; Child, Preschool; Chloramphenicol; Clindamycin; Humans; Infant; Infant, Newborn; Penicillin G; Penicillin Resistance

Cefamandole and cefoxitin, introduced only 7 years ago, are now the most commonly prescribed parenteral antibiotics in the United States. These drugs are similar to the first-generation cephalosporins in toxicity, but their in-vitro spectrum of activity is greater. Their serum half-lives are longer than those of cephalothin and cephapirin but shorter than that of cefazolin. Although cefamandole has been recommended in empiric therapy for patients with community-acquired pneumonia and as a prophylactic agent for patients having various surgical procedures, other regimens are less expensive and just as effective. Cefamandole should not be used to treat intra-abdominal, enterobacter, or ampicillin-resistant Haemophilus influenzae infections. Cefoxitin is effective in the treatment and prevention of mixed aerobic-anaerobic skin and soft-tissue, intra-abdominal, gynecologic, and penicillinase-producing, spectinomycin-resistant Neisseria gonorrhoeae infections. Cefoxitin represents a greater advance than cefamandole in our continuing search for safe and more effective antimicrobial agents.

Topics: Bacteria; Bacterial Infections; Cefamandole; Cefoxitin; Child; Costs and Cost Analysis; Drug Resistance, Microbial; Female; Humans; Infant; Kinetics; Premedication

Topics: Abdomen; Adult; Aged; Bacterial Infections; Cefoxitin; Emergencies; Female; Humans; Male; Middle Aged; Thoracic Surgery

A review is given of current antibiotic treatment of anaerobic infections. It is emphasized that infections with Bacteroides fragilis constitute the main problem, virtually all other anaerobe organisms of clinical significance are sensitive to penicillin. Particularly useful antibiotics for infections with B. fragilis are cefoxitin, chloramphenicol, clindamycin and the nitroimidazoles. Vancomycin is the drug of choice for pseudomembranous colitis provoked by Clostridium difficile.

Topics: Anaerobiosis; Anti-Bacterial Agents; Bacterial Infections; Bacteroides fragilis; Bacteroides Infections; Cefoxitin; Cephalosporins; Chloramphenicol; Clindamycin; Humans; Metronidazole; Penicillins; Tetracyclines; Tinidazole; Vancomycin

The therapy of gram-negative bacillary meningitis is less than adequate to date; the agents recommended do not achieve bactericidal levels in purulent cerebrospinal fluid. Because optimal antibiotic therapy of meningitis occurs when the cerebrospinal fluid level of an antibiotic is above the concentration needed to kill the offending pathogen, another group of agents needs to be considered. The newer cephalosporins or cehalosporin-type antibiotics (cefotaxime, moxalactam), by virtue of their marked activity against gram-negative bacilli and their ability to achieve significant CSF levels, merit serious consideration as therapy for gram-negative bacillary meningitis. Investigators in Europe and the United States have developed preliminary data demonstrating the efficacy of these agents in a growing number of cases. In the group presented herein, of the 35 cases in which gram-negative bacillary meningitis was treated with the newer cephalosporins, there were only four failures.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Blood-Brain Barrier; Cefamandole; Cefotaxime; Cefoxitin; Cephaloridine; Cephalosporins; Cephalothin; Cephamycins; Child, Preschool; Enterobacteriaceae; Female; Humans; Infant; Infant, Newborn; Male; Meningitis; Middle Aged; Moxalactam; Pseudomonas aeruginosa

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

Topics: Bacteria; Bacterial Infections; Cefamandole; Cefoxitin; Cephalosporins; Cephalothin; Drug Hypersensitivity; Humans; Injections

Cefoxitin is a beta-lactam antibiotic derived from cephamycin C, a naturally occurring substance produced by Streptomyces lactamdurans. Its resistance to destruction by beta-lactamases results in a broad spectrum of antibacterial activity which includes anaerobic as well as Gram-positive and Gram-negative aerobic bacteria, including many resistant to cephalothin and other cephalosporins. Given by intravenous or intramuscular injection, cefoxitin is effective against a wide variety of infections caused by Gram-positive or Gram-negative aerobes as well as by anaerobic bacteria. It is generally well tolerated, thrombophlebitis, skin rash and some degree of discomfort after intramuscular injection, being the most commonly reported side effects. Cefoxitin has not been shown to cause adverse effects on renal function.

Topics: Bacteria; Bacterial Infections; Cefoxitin; Cephalosporins; Drug Incompatibility; Drug Stability; Humans; Kinetics

Since the introduction of cephalothin and cephaloridine as the first parenteral cephalosporins and cephalexin as the first member of the group which is absorbed from the gastrointestinal tract, several new cephalosporin derivatives have been developed. Most of these have no major advantages over cephalothin, cephaloridine or cephalexin. Increased knowledge about the importance of beta-lactamases for bacterial resistance against beta-lactam antibiotics has focused interest on development of drugs with increased resistance to degradation by these enzymes. Among the caphalosporins, cefamandole and cefuroxime have been found to be markedly more active against beta-lactamase producing Gram-negative bacteria. A new group of beta-lactam antibiotics, the cephamycins, have been introduced with cefoxitin as the first clinically useful member. Cefoxitin has the spectrum of a beta-lactamase-resistant cephalosporin and is also active against Bacteroides fragilis. The review concentrates on the antibacterial spectrum of these three new antibiotics and on their clinical efficacy.

Topics: Bacteria; Bacterial Infections; Cefamandole; Cefoxitin; Cephalosporinase; Cephalosporins; Cephamycins; Clinical Trials as Topic; Drug Evaluation; Drug Resistance, Microbial; Furans; Humans; Penicillinase

To determine the rate of prophylactic antibiotics usage in uncomplicated gynecologic abdominal surgery in Siriraj Hospital, before and after guideline implementation.. Two hundred and fifty-eight women who underwent elective gynecologic surgery for a benign condition were enrolled. The patients were divided into two groups, before and after guideline implementation (control and study group). Medical records of these women were reviewed to determine the rate of prophylactic antibiotics usage, rate of postoperative infection, and antibiotics cost.. The most common prophylactic antibiotics used were Cefazolin (41.9%), Cefoxitin (36.4%), and Augmentin (9.7%). Rate of single dose of cefazolin usage were not significantly different between the two groups (10.1% and 12.4% respectively, p = 0.482). However, the rate of postoperative oral antibiotic usage was significantly decreased (31.8% and 14.7% respectively, p = 0.001). The reduction of oral antibiotic usage was significant among staff only. The rate of postoperative infection between control and study groups, as well as between single and other antibiotic prophylaxis were similar. Had a single dose of cefazolin been administered to all patients, the antibiotics cost would have been reduced by 102,012 Baht or 91.8%.. Rate of a single dose of cefazolin usage as antibiotic prophylaxis in gynecologic surgery was similar to before guideline implementation. However, postoperative oral antibiotics usage decreased significantly, especially among the staff.

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacterial Infections; Cefazolin; Cefoxitin; Drug Utilization Review; Elective Surgical Procedures; Female; Gynecologic Surgical Procedures; Hospital Costs; Humans; Surgical Wound Infection; Thailand

We investigated the association between endometritis and reproductive morbidity.. Participants were 614 women in the PID Evaluation and Clinical Health (PEACH) Study with pelvic pain, pelvic organ tenderness, and leukorrhea, mucopurulent cervicitis, or untreated cervicitis. We compared women with endometritis (>or=5 neutrophils or >or=2 plasma cells), Neisseria gonorrhoeae or Chlamydia trachomatis upper genital tract infection (UGTI) or both to women without endometritis/UGTI for outcomes of pregnancy, infertility, recurrent pelvic inflammatory disease (PID), and chronic pelvic pain (CPP), adjusting for age, race, education, PID history, and baseline infertility.. Endometritis/UGTI was not associated with reduced pregnancy (odds ratio [OR] 0.8, 95% CI 0.6-1.2) or elevated infertility (OR 1.0, 95% CI 0.6-1.6), recurrent PID (OR 0.6, 95% CI 0.4-0.9), or CPP (OR 0.6, 95% CI 0.4-0.9). PEACH participants with and without endometritis/UGTI had higher age- and race-specific pregnancy rates than 1997 national rates.. Among women with clinically suspected mild-to-moderate PID treated with standard antibiotics, endometritis/UGTI was not associated with reproductive morbidity.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Bacteria, Anaerobic; Bacterial Infections; Cefoxitin; Chlamydia Infections; Doxycycline; Endometritis; Endometrium; Female; Gonorrhea; Humans; Infertility, Female; Odds Ratio; Pelvic Inflammatory Disease; Pregnancy; Probenecid; Time Factors

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

Trovafloxacin is a new fourth-generation fluoroquinolone whose pharmacokinetics and in vitro activity suggest that it is well suited for antibiotic prophylaxis in elective hysterectomy.. In a randomized, double-blind, multicenter study, parallel groups of women 18 years of age or older received either 200 mg trovafloxacin by mouth and intravenous (i.v.) placebo or 2 g cefoxitin by i.v. infusion and placebo by mouth before elective vaginal or abdominal hysterectomy for nonmalignant disease.. In the 103 and 97 patients in the trovafloxacin and cefoxitin groups, respectively, who were evaluable for efficacy, the prophylactic success rates at hospital discharge (96% in both groups) and 30 +/- 6 days after hysterectomy (88% and 91% in the trovafloxacin and cefoxitin groups, respectively) were statistically equivalent. Both antibiotics were well tolerated.. A single oral 200 mg dose of trovafloxacin is as effective and safe as a standard cefoxitin parenteral regimen in the prevention of primary bacterial infection after elective vaginal or abdominal hysterectomy for nonmalignant disease.

Topics: Administration, Oral; Adult; Aged; Anti-Infective Agents; Antibiotic Prophylaxis; Bacterial Infections; Cefoxitin; Cephamycins; Double-Blind Method; Elective Surgical Procedures; Female; Fluoroquinolones; Humans; Hysterectomy; Hysterectomy, Vaginal; Infusions, Intravenous; Middle Aged; Naphthyridines; Surgical Wound Infection

Acute appendicitis is the most common acute surgical disease in childhood and it still presents frequent septic complications. This prospective and randomized study compares the efficacy of two cephalosporins (cefoxitin and ceftizoxime) in terms of clinical response, in vitro activity and characteristics of use in clinical practice.. Of the 288 children with acute appendicitis admitted over a period of 15 months, 148 received cefoxitin (100 mg/kg/24 h; Group I) and 140 ceftizoxime (100 mg/kg/24 h; Group II) RESULTS: No significant differences were seen between these two groups in clinical response or infectious complication rates. In addition, activities of both antimicrobial agents against pathogens recovered from the peritoneal cultures of all patients were similar. The overall most common isolates were E. coli (75.5%), bacteroides species (33.7%) and Pseudomonas (32.4%).. We conclude that ceftizoxime is as effective as cefoxitin and can be surely employed in the treatment of acute appendicitis in children. Its addition, its longer half-life simplifies its use in clinical practice.

Topics: Acute Disease; Adolescent; Appendicitis; Bacterial Infections; Cefoxitin; Ceftizoxime; Cephalosporins; Cephamycins; Child; Child, Preschool; Female; Humans; Infant; Male; Postoperative Complications; Prospective Studies

To test the hypothesis that comprehensive broad-spectrum empirical antimicrobial therapy is superior to limited-spectrum empirical antimicrobial therapy in intra-abdominal infections.. Prospective, randomized, double-blinded study.. University-affiliated hospitals in Canada.. Two hundred thirteen patients with intra-abdominal infections and planned operative or percutaneous drainage.. Limited-spectrum empirical antimicrobial therapy consisted of cefoxitin sodium, 2 g, intravenously, every 6 hours (n = 109). Comprehensive broad-spectrum empirical antimicrobial therapy consisted of a combination of imipenem and cilastatin sodium, 500 mg, intravenously, every 6 hours (n = 104).. Failure to cure the intra-abdominal infection (persistence of infection or death).. Of initial isolates, 98% were sensitive to imipenem plus cilastin sodium compared with 72% for cefoxitin. No difference was found in the failure rate between treatment groups. Among various reasons for failure (including technical), 12 of 80 patients in the limited-spectrum empirical antimicrobial therapy group had resistant organisms at a second intervention compared with 1 of 74 in the comprehensive broad-spectrum empirical antimicrobial therapy group (P < .003, chi 2). One death in the limited-spectrum empirical antimicrobial therapy group was due to autopsy-proved disseminated Pseudomonas aeruginosa (blood, peritoneum, lung, and pleural fluid) that was resistant to cefoxitin, and the other was associated with peritonitis due to cefoxitin-resistant Enterobacter cloacae. One death in the comprehensive broad-spectrum empirical antimicrobial therapy group was associated with peritonitis from Clostridium perfringens that was sensitive to imipenem plus cilastin sodium, and the other was associated with peritonitis from Pseudomonas aeruginosa that was resistant to imipenem plus cilastin sodium.. Treatment failure of intra-abdominal infection may be due, in part, to the presence of resistant pathogens at the site of infection. Therefore, routine culture of these sites seems worthwhile and empirical therapy should be as comprehensive as possible and should cover all potential pathogens.

Topics: Abdomen; Antibiotic Prophylaxis; Bacteria; Bacterial Infections; Cause of Death; Cefoxitin; Cephamycins; Cilastatin; Double-Blind Method; Drainage; Drug Resistance, Microbial; Female; Humans; Imipenem; Injections, Intravenous; Intraoperative Care; Male; Middle Aged; Peritonitis; Prospective Studies; Protease Inhibitors; Thienamycins; Treatment Failure; Treatment Outcome

The authors present their experience from a prospective randomized study of therapeutic effects of a combination of pefloxacine (Abaktal) and klindamycin with cefoxitine in patients after hepatobiliary and pancreatic surgery. The therapeutic results in both investigated groups were evaluated in more than 95% patients as excellent, without statistically significant differences. The authors provided evidence of a comparable effectiveness of a combination of pefloxacine with klindamycin and the effectiveness of cefoxitine in patients after the above mentioned types of surgery, while treatment was cheaper when a combination of pefloxacine and klindamycin was used and moreover there was the possibility of oral administration of these preparations, as soon as the patients' condition made it possible.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Antibiotic Prophylaxis; Bacterial Infections; Biliary Tract Surgical Procedures; Cefoxitin; Clindamycin; Female; Humans; Liver; Male; Middle Aged; Pancreas; Pefloxacin; Postoperative Complications; Prospective Studies

The efficacy and safety of two antibiotic regimens for the treatment of acute pelvic inflammatory disease (PID) was compared in a prospective and randomised study. 57 patients received either 0.2 gms ciprofloxacin intravenously b.i.d. in combination with 0.5 g metronidazole intravenously t.i.d. (n = 26), or alternatively 2 g cefoxitin intravenously t.i.d. in combination with doxycycline 0.1 g b.i.d. (n = 31). After commencing therapy intravenously, medication with ciprofloxacin, metronidazole and doxycycline was continued orally after two or three days. In the ciprofloxacin/metronidazole group, PID was found to be severe in 7, moderate in 12 and mild in 7 patients. The numbers in the cefoxitin/doxycycline group were 8, 20 and 3 respectively. The clinical result after treatment with ciprofloxacin/metronidazole was resolution of all symptoms in 24 patients and improvement in 2 others. In the cefoxitin/doxycycline treated group, resolution was found in 27 patients, improvement in 2 others. Failure occurred in 2 patients. 53 different microorganisms as the suspected cause of PID were isolated in the ciprofloxacin/metronidazole group and 56 in the cefoxitin/doxycycline group. According to our clinical and bacteriological criteria, treatment for PID was successful in 97% of the ciprofloxacin/metronidazole group and in 87% of the cefoxitin/doxycycline group. Adverse reactions were found in 4 patients in the ciprofloxacin/metronidazole treated group. Therapy had to be terminated in 3 of these patients. In the cefoxitin/doxycycline group 2 patients had adverse reactions, and therapy had to be terminated in one of these patients. According to our results, both antibiotic regimens can be recommended for the treatment of PID.

Topics: Adult; Bacterial Infections; Bacteriological Techniques; Cefoxitin; Ciprofloxacin; Dose-Response Relationship, Drug; Doxycycline; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Metronidazole; Pelvic Inflammatory Disease; Prospective Studies

As has been proved before, antibiotic prophylaxis is highly effective in lowering wound infection rates in colorectal surgery. In order to establish quality control, we checked the effectiveness of three different prophylactic antibiotic regimes in 422 patients in a prospective and randomized trial. Between the three groups were no significant differences as regards age, type of operation and risk factors like adipositas and diabetes. The wound infection rate according to CDC-criteria was from 7.0 to 9.5%. We did not find a significant difference between the three antibiotic regimes. It is therefore our conclusion, that in our setting each of the three different types of antibiotics is of equal value. This means, on the other hand, that the cheapest one is enough.

Topics: Aged; Ampicillin; Anti-Bacterial Agents; Bacterial Infections; Cefoxitin; Colitis, Ulcerative; Colonic Polyps; Colorectal Neoplasms; Diverticulitis, Colonic; Drug Therapy, Combination; Elective Surgical Procedures; Female; Humans; Male; Metronidazole; Middle Aged; Piperacillin; Premedication; Prospective Studies; Quality Assurance, Health Care; Sulbactam; Surgical Wound Infection

A double-blind trial was conducted in 385 patients with suspected bacterial intra-abdominal infections to compare the efficacy and safety of ampicillin-sulbactam with cefoxitin. Patients were randomized to receive either 3 g ampicillin-sulbactam (2 g ampicillin-1 g sulbactam), or 2 g cefoxitin, every 6 hours. To be evaluable, patients had to demonstrate positive culture evidence of peritoneal infection at the time of operation. A total of 197 patients were evaluable for clinical efficacy. The two treatment groups were comparable in demographic features and in the presence of risk factors for infection. Clinical success (absence of infection and of adverse drug reaction) was observed in 86% of patients in the ampicillin-sulbactam group and 78% in the cefoxitin group. Eradication of infection occurred in 88% of the ampicillin-sulbactam group and 79% of the cefoxitin group. There were no differences in the nature or frequency of side effects observed in the two groups. Ampicillin-sulbactam demonstrated no difference in safety or efficacy when compared with cefoxitin in the treatment of serious intra-abdominal infections of bacterial origin.

Topics: Abdomen, Acute; Adult; Ampicillin; Bacterial Infections; Cefoxitin; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Peritonitis; Prospective Studies; Sulbactam

The optimal duration of antibiotic use in penetrating abdominal trauma is incompletely defined. It is generally accepted that short-term antibiotics are appropriate for low-risk wounds. However, with colon injury and significant degree of injury, abdominal trauma index (ATI) more than 25, concern exists that short-term treatment is not adequate.. The study was a prospective double-blind trial of 24-hour treatment (cefoxitin or cefotetan) compared with 5-day treatment in 515 patients. Major abdominal infections (MAI) included abscess, necrotizing fasciitis, and diffuse peritonitis.. MAI occurred in 8% of those patients with 1-day therapy and 10% with 5-day therapy. Subgroup analysis of high-risk groups (colon wounds and ATI of more than 25) showed the following MAI rates: colon, 1-day therapy, 14%; 5-day therapy, 15%; ATI of more than 25, 1-day therapy, 17%; 5-day therapy, 30%.. Regardless of contamination and degree of injury, 24-hour antibiotic therapy is satisfactory for all penetrating abdominal trauma.

Topics: Abdominal Injuries; Adult; Analysis of Variance; Bacterial Infections; Cefotetan; Cefoxitin; Double-Blind Method; Drug Administration Schedule; Humans; Prospective Studies; Time Factors; Treatment Outcome; Wounds, Penetrating

In this comparative, randomized, multicenter trial, 273 patients scheduled for gynecologic surgery were studied: 87 received a single 1-g dose of cefotaxime 30 minutes before surgery; 81 were given a 1-g dose of cefoxitin 30 minutes before surgery and 1 g every 6 hours for 24 hours after surgery (total dose 4 g); and 105 received a 1-g dose of cefazolin 30 minutes before surgery, followed by 1 g every 8 hours for 48 hours (total dose 6 g). Patients who received cefotaxime had a significantly lower incidence of postoperative fever compared with those treated with cefoxitin or cefazolin (p < 0.01). The incidence of positive urinary cultures was lower in the cefotaxime and cefazolin groups when compared with the cefoxitin group (p < 0.01 and p < 0.05, respectively). The results of this study confirm the efficacy of cefotaxime as prophylaxis in surgical infections and demonstrate that single-dose cefotaxime is more effective than a four-dose regimen of cefoxitin.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefazolin; Cefotaxime; Cefoxitin; Cephalosporins; Drug Administration Schedule; Female; Genitalia, Female; Humans; Middle Aged; Postoperative Complications; Premedication

The authors report three trials of B-lactams and carbapenems for soft tissue infections treated on a surgical service: 1) cefmetazole versus cefoperazone, n = 44; 2) cefotetan versus cefoxitin, n = 24; and 3) meropenem versus imipenem, n = 44. A total of 138 hospitalized patients were enrolled with 112 meeting evaluability criteria. Four hundred twenty-three isolates were cultured (mean, three/patient) of which 67 per cent were aerobes and 33 per cent anaerobes. Cure rates for each trial were: 1) 93 per cent; 2) 92 per cent; 3) 100 per cent. Failures were caused by resistant organisms (Streptococcus group D, Bacteroides fragilis and Pseudomonas) appearing in incompletely drained infection sites. Three patients receiving meropenem had adverse effects (headache, nausea) and one receiving cefoxitin (truncal rash). Operative drainage and debridement remain the critical elements in therapy. Agents with longer half lives allowing twice daily dosing (cefmetazole and cefotetan) were as effective and less expensive than multiple doses of short-acting agents. The extended spectrum carbapenems are most useful for severe infections or resistant organisms.

Topics: Adult; Aged; Bacterial Infections; Carbapenems; Cefmetazole; Cefoperazone; Cefotetan; Cefoxitin; Cephalosporins; Drug Combinations; Drug Resistance, Microbial; Escherichia coli Infections; Female; Humans; Imipenem; Male; Meropenem; Middle Aged; Prospective Studies; Remission Induction; Skin Diseases, Infectious; Staphylococcal Infections; Streptococcal Infections; Thienamycins

A prospective randomized study was undertaken to compare the use of the combination of gentamicin and clindamycin with single agent, cefoxitin, in the treatment of perforated appendicitis in the pediatric patient. In a 3-year period from 1986 to 1989, 56 patients with perforated appendicitis were randomized. Twenty-nine patients received cefoxitin, and 27 patients received gentamicin and clindamycin. Antibiotics were started before operation and continued for a minimum of 6 days after operation. Skin and subcutaneous tissues were left open at surgery and closed secondarily after day 3, if they appeared to be clean. Wounds were considered infected if they developed increased purulence with positive wound cultures. Age range was similar in both groups, with a mean of 9 years (range, 1 to 17 years); 28 were boys and 28 were girls. No changes in antibiotics were required for reasons of susceptibility. No adverse drug reactions occurred in either group. The most common organisms were Escherichia coli in 35 cases (62%) and Bacteroides species in 26 cases (46%). No difference was noted in infection complications in the two groups nor in length of hospital stay. Therefore, no difference is evident in the use of cefoxitin versus gentamicin and clindamycin in the treatment of perforated appendicitis in terms of disease or drug-related complications.

Topics: Adolescent; Appendicitis; Bacterial Infections; Cefoxitin; Child; Child, Preschool; Clindamycin; Drug Therapy, Combination; Female; Gentamicins; Humans; Intestinal Perforation; Male; Prospective Studies

The introduction of antibiotic prophylaxis for cesarean delivery has decreased the risk of postpartum endometritis and wound infection, but factors that contribute to prophylaxis failure are not understood. To determine factors that might contribute to postpartum infections following antibiotic prophylaxis, we cultured amniotic fluid, decidua, and chorioamniotic membrane specimens for anaerobic and facultative bacteria and for genital mycoplasmas at cesarean delivery. Women were assessed daily for the development of infections, and if endometritis developed, a protected endometrial culture was obtained. Postpartum endometritis developed in 16 and wound infection in four of 102 women. Infection rates were similar for women receiving cefotetan (N = 50) or cefoxitin (N = 52) for prophylaxis. The isolation of group B streptococcus (P less than .001) or Enterococcus faecalis (P = .03) from the upper genital tract at delivery was significantly associated with postpartum endometritis. Antibiotic-resistant organisms (other than enterococci) were recovered uncommonly at delivery or with postpartum infections. Group B streptococcus was susceptible to the prophylactic agents used, suggesting that virulence factors other than antibiotic resistance are important for the development of postpartum endometritis. Group B streptococcus, E faecalis, and bacteria associated with bacterial vaginosis were recovered from the endometrium at the time of postpartum endometritis.

Topics: Bacterial Infections; Cefotetan; Cefoxitin; Cesarean Section; Double-Blind Method; Endometritis; Endometrium; Extraembryonic Membranes; Female; Humans; Placenta; Postoperative Complications; Pregnancy; Premedication; Surgical Wound Infection

We report the results of a randomized, double-blind comparison of short-term versus long-term cefoxitin prophylaxis against infections after radical abdominal hysterectomy with pelvic and para-aortic lymphadenectomy. Of 113 evaluable patients, 54 (47.8%) received short-term (three doses) and 59 (52.2%) long-term (12 doses) prophylaxis with intravenous cefoxitin (2 g per dose). No significant differences in demographics, preoperative risk factors, or clinical course were detected between the two groups; nor did we detect significant differences in the incidence of surgical-site-related infections (7.4 versus 5.1%, respectively, P = .61), postoperative urinary tract infection, or other febrile morbidity. We conclude that short-term and long-term cefoxitin prophylaxis are equally effective for the prevention of post-operative surgical-site-related infections after radical hysterectomy.

Topics: Adult; Bacterial Infections; Cefoxitin; Female; Follow-Up Studies; Humans; Hysterectomy; Middle Aged; Postoperative Complications; Prospective Studies; Surgical Wound Infection; Uterine Cervical Neoplasms

This was a prospective, randomized study of 123 patients with penetrating abdominal injuries. The patients received ceftriaxone or cefoxitin for 24 h (in the presence of colonic injury, 48 h). The overall incidence of abdominal sepsis was 7.3 per cent (ceftriaxone 5 per cent, cefoxitin 9.5 per cent, P greater than 0.05). Colonic injury was the most important risk factor for the development of septic complications. Other factors, such as the weapon used, a prehospital time longer than 4 h, shock on admission, multiple organ injuries, and small bowel perforation, did not influence the incidence of sepsis.

Topics: Abdominal Injuries; Adult; Bacterial Infections; Cefoxitin; Ceftriaxone; Colon; Female; Humans; Male; Multiple Trauma; Postoperative Complications; Premedication; Prospective Studies; Risk Factors; Wounds, Penetrating

Previous in vitro, in vivo, and a preliminary clinical report have demonstrated efficacy of noncovalently bonding antibiotics to the surface of continuous ambulatory peritoneal dialysis (CAPD) catheters in decreasing infectious complications. A larger prospective randomized clinical trial was completed. Eighty-six patients with chronic renal failure were enrolled in the study and randomized to receive either a surfactant treated or untreated control catheter. All catheters were soaked in cefoxitin at the time of insertion. Groups were comparable in terms of pre-existing illnesses, age, and gender. No differences were shown in the incidence of catheter-tract infections, peritonitis or mechanical complications. There was also no differences in microbiologic culture results. Therefore, it is concluded that this clinical trial did not demonstrate a reduction in catheter-related infectious complications by antibiotic bonding.

Topics: Bacterial Infections; Catheters, Indwelling; Cefoxitin; Female; Humans; Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Prospective Studies; Quaternary Ammonium Compounds; Surface-Active Agents

The combination of sulbactam-ampicillin was compared to cefoxitin for the treatment of acute salpingitis in 40 women divided into two groups of 20 women each. There were 11 patients in each group who were given doxycycline because of evidence of chlamydial infection. All patients were diagnosed by laparoscopic examination and evaluated by the same procedure 7-12 weeks later: At the second laparoscopy, only 1 of the 20 patients (5%) treated with sulbactam/ampicillin had severe adhesions, while 6 of the 20 patients (40%) treated with cefoxitin had severe adhesions. Tubal patency was without obstruction in 14 patients (70%) given the combination treatment and in 12 patients (60%) given cefoxitin. Side effects were essentially absent in both groups.

Topics: Adult; Ampicillin; Bacterial Infections; Cefoxitin; Drug Therapy, Combination; Evaluation Studies as Topic; Female; Humans; Laparoscopy; Prognosis; Salpingitis; Sulbactam

To describe the microbiologic etiology of post-cesarean endometritis developing after perioperative cephalosporin prophylaxis, endometrial samples were obtained from 27 women with a triple-lumen catheter. The women were assigned in a double-blind, randomized fashion to receive either ticarcillin/clavulanate, 3.1 g, or cefoxitin, 2 g, administered every six hours, until the clinical signs of infection resolved. A total of 149 microorganisms (84 facultative and 65 obligate anaerobes) were recovered from 26 women, for a mean of 5.5 isolates per specimen. One endometrial specimen was sterile. Bacteroides and Peptostreptococcus species were the most frequent isolates, followed by Gardnerella vaginalis, Enterococcus, facultative gram-negative rods and Mycoplasma hominis. Each of the isolates was tested for beta-lactamase activity. At least one beta-lactamase-producing isolate was recovered from 56% of the specimens. Susceptibility testing of endometrial isolates demonstrated that 96% of 118 potential pathogens (Gardnerella, Bacteroides, Peptostreptococcus, enterococci and streptococci) were susceptible to ticarcillin/clavulanate. By comparison, 86% of these isolates were susceptible to cefoxitin in vitro. Women who were treated with ticarcillin/clavulanate were less likely to have a temperature greater than 38 degrees C for two or more days (8% vs. 57%, P = .01). Also, there was a trend toward a decreased duration of uterine tenderness in the ticarcillin/clavulanate group, but it did not attain statistical significance (60% vs. 86%, P = .4). However, the overall clinical success rate with these single-agent treatments was not different for the two groups (77% vs. 79%, P = 1.0).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Bacterial Infections; Bacteroides; Cefoxitin; Cephalosporins; Cesarean Section; Clavulanic Acids; Double-Blind Method; Drug Evaluation; Drug Therapy, Combination; Endometritis; Female; Humans; Penicillins; Peptostreptococcus; Postoperative Complications; Pregnancy; Randomized Controlled Trials as Topic; Ticarcillin

Ceftizoxime and cefoxitin, two parenteral broad-spectrum cephalosporin antibiotics, were compared in a prospective, randomized, double-blind study to determine if they are clinically equivalent in the treatment of infections of the urinary or respiratory tracts, the intra-abdominal cavity, or skin and skin structure. Since the pharmacokinetic properties of ceftizoxime permit less frequent dosing than cefoxitin and, in consequence, lower daily doses, a second objective was to compare the cost of intravenous use of these antibiotics in hospital practice. Patients were assigned at random to treatment with either 4 to 8 gm/day of cefoxitin or 2 to 4 gm/day of ceftizoxime. Within each treatment group, they were stratified according to the site of the infection. Cure rates were similar with ceftizoxime (96% of 134 patients) and cefoxitin (92% of 132 patients). There were no statistically significant differences with respect to site or severity of infection. An analysis of the cost of the drugs and the labor to administer them showed ceftizoxime to be less expensive ($263 to $389/day) than cefoxitin ($394 to $638/day).

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacterial Infections; Cefoxitin; Ceftizoxime; Costs and Cost Analysis; Double-Blind Method; Female; Humans; Infusions, Intravenous; Male; Middle Aged; Multicenter Studies as Topic; Therapeutic Equivalency

Mixed results have been obtained in several studies using tocolysis or antibiotics individually in the treatment of premature rupture of membranes (PROM). We compared the outcomes of a management protocol consisting of tocolysis, prophylactic antibiotic administration, and documentation of pulmonary maturity with a control group treated with passive expectant management for premature rupture of membranes. There were 55 women in the treatment group and 57 women in the control group. The mean latent phase (+/- SEM) in the treatment group was 7.34 (+/- 1.25) days compared with 1.86 (+/- .431) days in the control group (P less than .001). Eighteen of 55 patients (33%) in the treatment group were electively delivered after documentation of lung maturity, contributing to a falsely lowered mean latent phase in the treatment group. Twenty-four patients in the treatment group and 6 in the control group had a latent phase of 5 days or greater (P = .00018). There were 9 postpartum infections in the control group and 10 infections in the treatment group (P = NS). There was no difference in the length of latent phase of patients treated with ceftizoxime compared with the other antibiotics used (cefoxitin, cefazolin, ampicillin), although postpartum ceftizoxime was more effective in preventing postpartum infections (1 of 28 vs 9 of 27) (P = .005). There were fewer infected neonates in the study group, but this was not significant. It appears that treatment with this protocol significantly prolongs the latent phase in patients with preterm PROM without increasing infectious morbidity.

Topics: Adult; Ampicillin; Anti-Bacterial Agents; Bacterial Infections; Cefazolin; Cefoxitin; Ceftizoxime; Female; Fetal Membranes, Premature Rupture; Fetal Monitoring; Fetal Organ Maturity; Humans; Infant, Newborn; Lung; Obstetric Labor, Premature; Pregnancy; Puerperal Infection; Retrospective Studies; Tocolysis; Uterine Contraction

The identification of pathogens and the early recognition of pelvic infections in patients after hysterectomy, cesarean delivery and vaginal delivery were analyzed. Criteria for administering cephamycin therapy were established, as were guidelines for evaluating the progress of the infection. In a comparative study of the safety and efficacy of cefmetazole and cefoxitin in 145 hospitalized patients with pelvic infections there were no significant differences between either the bacteriologic or clinical cure rates of the two antibiotics. Both were efficacious and safe for the treatment of obstetric-gynecologic soft tissue infections.

Topics: Bacterial Infections; Cefmetazole; Cefoxitin; Cesarean Section; Delivery, Obstetric; Female; Humans; Hysterectomy; Pelvic Inflammatory Disease; Pregnancy; Prospective Studies

The purpose of this present study was to determine whether intraoperative antibiotic uterine irrigation was effective in reducing febrile morbidity (Part 1), and to determine whether ticarcillin disodium (Ticar) or cefoxitin sodium (Mefoxin) was the more effective solution (Part 2). The indications for cesarean section had an effect on febrile morbidity. In patients having nonelective cesarean section, febrile morbidity was high, occurring in 62.7% of the saline control group and 32.9% of those receiving ticarcillin disodium irrigation. In patients having elective cesarean section, febrile morbidity was lower (28% in the saline control group and 8.3% in the ticarcillin group [P less than or equal to .05]). Ticarcillin and cefoxitin were equal in reducing postoperative febrile morbidity. The use of prophylactic antibiotics, therefore, is indicated both in high-risk patients having nonelective cesarean section and in low-risk patients having elective repeat cesarean section.

Topics: Adult; Bacterial Infections; Cefoxitin; Cesarean Section; Double-Blind Method; Drug Evaluation; Female; Fever; Humans; Intraoperative Care; Penicillins; Postoperative Complications; Poverty; Pregnancy; Premedication; Puerperal Infection; Sodium Chloride; Therapeutic Irrigation; Ticarcillin; Uterus

Prophylactic antibiotics are given routinely to patients undergoing surgical treatment of the biliary tract to prevent postoperative infection if risk factors for postoperative sepsis are present. Cefmetazole (CM) is a new broad spectrum parenteral cephamycin antibiotic. This drug possesses a spectrum of activity against a wide range of gram-negative and gram-positive bacteria that is similar to cefoxitin (CX), an antibiotic widely used for prophylaxis with operations upon the abdomen. In this study, there was a random selection of two patients to receive CM to every one patient to receive CX. The dose of CM was 1 gram given intravenously every eight hours for three doses beginning 30 minutes before the operation; three doses of CX were given intravenously, 2 grams every six hours. Fifty-two evaluable patients comprised the CM group and 26, the CX group. The risk factors for postoperative infection were acute cholecystitis (CM, seven patients; CX, one patient), evidence from imaging procedure suggesting need for exploration of the common duct (CM, six; CX, one), hyperbilirubinemia (CM, eight; CX, four), hyperamylasemia (CM, 17; CX, seven); age of 60 years or more (CM, six; CX, one), obesity (CM, 36; CX, 14) and diabetes mellitus (CM, four; CX, five). Operative bactibilia and the organisms were comparable in both groups. Postoperative days of fever greater than or equal to 38 degrees C. (oral) (CM, 0.83 +/- 1.20; CX, 0.58 +/- 0.96) and hospitalization (CM, 6.59 +/- 2.20; CX, 5.04 +/- 1.26) were similar. Postoperative septic complications at the operative site occurred in two patients in the CM group (4 per cent) and in none of the patients in the CX group (p = 0.4; N.S., Fischer exact test). These two antibiotics had similar efficiency in preventing postoperative infections.

Topics: Adult; Aged; Bacterial Infections; Cefmetazole; Cefoxitin; Cholecystectomy; Double-Blind Method; Drug Administration Schedule; Drug Evaluation; Female; Humans; Male; Middle Aged; Premedication; Randomized Controlled Trials as Topic; Risk Factors; Surgical Wound Infection

Two hundred fourteen women having vaginal or abdominal hysterectomy were entered into a prospective, randomized, blind clinical trial comparing a preoperative intravenous dose of piperacillin to three perioperative intravenous doses of cefoxitin given over an eight-hour period. Interregimen clinical, surgical, and outcome variables of the 207 evaluable subjects were statistically similar, but there were significant interprocedure differences in a variety of categories; many benefits exist when vaginal hysterectomy is possible. Efficacy of a single dose of piperacillin was similar to that of three cefoxitin doses. Seven women (3.4%) had major postoperative infection requiring parenteral antimicrobial therapy, two (1.9%) after vaginal hysterectomy and five (4.8%) after abdominal hysterectomy. Three of the latter five infections (60%) occurred after discharge from the hospital. Even with prophylaxis, postoperative anemia was associated with increased frequency of infection at the operative site after both procedures, and diabetes was associated with late infection of the abdominal incision after abdominal hysterectomy.

Topics: Adult; Bacterial Infections; Cefoxitin; Clinical Trials as Topic; Drug Administration Schedule; Female; Humans; Hysterectomy; Hysterectomy, Vaginal; Length of Stay; Middle Aged; Piperacillin; Postoperative Complications; Premedication; Prospective Studies; Random Allocation

Susceptibility of anaerobic clinical isolates from the United States, Canada, and Germany to sulbactam/ampicillin (1 + 2) (SBT/AMP), ampicillin alone (AMP), and cefoxitin (CFX) was determined with a standard agar dilution test. The isolates included 192 strains of Bacteroides fragilis, 132 strains of other Bacteroides spp., and 19 strains of Clostridium spp. Against all species tested, SBT/AMP was more active than AMP or CFX. Results obtained by a new model of associative susceptibility testing indicated that susceptibility testing of single pathogens from polymicrobial infections is not necessarily reflective of the susceptibility of the pathogens at the site of infection. The results suggest that sulbactam is effective in associations of pathogens producing beta-lactamases of Richmond-Sykes types II-V and beta-lactamases of anaerobic bacteria.

Topics: Ampicillin; Bacteria, Anaerobic; Bacterial Infections; Bacteroides; Cefoxitin; Clostridium; Drug Therapy, Combination; Humans; Microbial Sensitivity Tests; Multicenter Studies as Topic; Sulbactam

In this comparative study, both cefmetazole and cefoxitin were found to be safe and effective in the treatment of skin and soft tissue infections. Greater activity of cefmetazole against some strains of Staphylococcus aureus, Streptococcus pneumoniae, beta-haemolytic streptococci and aerobic Gram-negative bacilli was confirmed. A 90% or better cure rate was achieved with both drugs. At late follow up, three patients treated initially with cefmetazole had recurrent signs and symptoms. However, these three patients had vascular insufficiency which predisposed them to infection. Since cefmetazole has a longer half-life than cefoxitin, it may prove to be more convenient, or more cost effective, or both, in these and other infections.

Topics: Adult; Aged; Bacterial Infections; Cefmetazole; Cefoxitin; Female; Humans; Male; Middle Aged; Prospective Studies; Random Allocation; Skin Diseases, Infectious

A prospective and randomized clinical study was conducted in order to compare cefoxitin (CFX) and ceftizoxime (CZX) as prophylactic antibiotics. Two hundred and three consecutive cases of elective upper gastrointestinal tract surgery, performed at our institute between January, 1983, and March, 1986, were entered in the trial. The patients were assigned randomly, before surgery, to the CFX or to the CZX group. Two grams of the assigned antibiotic was first administered during surgery and then continued at a dose of 1 gram, every 8 hrs for a total of 4 days. One patient was withdrawn from the study due to an allergic reaction. Both groups were comparable in sex, age, underlying disease, diagnosis, operation, and preoperative laboratory data. There were 18 infections related to the operation in the CFX group, while there were only 3 in the CZX group (p less than 0.001). The number of unrelated infections in each group was 6 and 6 respectively (NS). No special differences were found between the two groups regarding the kinds of microorganisms isolated, and no significant differences were seen in the adverse effects of either antibiotic. Our study demonstrated that ceftizoxime was more efficient than cefoxitin in preventing postoperative infection, following upper gastrointestinal tract surgery.

Topics: Adult; Aged; Aged, 80 and over; Bacterial Infections; Cefoxitin; Ceftizoxime; Digestive System Surgical Procedures; Female; Humans; Male; Middle Aged; Postoperative Complications; Premedication; Prospective Studies; Random Allocation

Topics: Adolescent; Adult; Bacterial Infections; Cefmetazole; Cefoxitin; Cephamycins; Clinical Trials as Topic; Drug Evaluation; Female; Gram-Negative Bacteria; Humans; Male; Middle Aged; Prospective Studies

In a multicenter study the prophylactic efficacy of two antibiotic regimens was tested against postoperative septic complications following elective colorectal surgery. The study was conducted in a prospective block-randomized design. Patients were preoperatively allocated to either ampicillin, 1 gm, four times daily, and metronidazole, 0.5 gm, three times daily, for 72 hours, or to cefoxitin, 2 gm, given three times in a period of 10 hours. Both regimens were initiated immediately before surgery. Forty-five patients were withdrawn from the study after randomization. Three hundred fifty two patients (175 receiving ampicillin and metronidazole and 177 receiving cefoxitin) completed the study and were followed for one month postoperatively. The frequency of septic and nonseptic complications was not statistically significant different between the two regimens. About one third of all septic complications appeared more than two weeks after surgery. It is concluded that short-term treatment with cefoxitin is at least as efficient as a three-day treatment with ampicillin and metronidazole.

Topics: Aged; Ampicillin; Bacterial Infections; Cefoxitin; Colon; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Male; Metronidazole; Multicenter Studies as Topic; Postoperative Complications; Premedication; Prospective Studies; Random Allocation; Rectum

In a randomised clinical trial, 102 women who underwent vaginal hysterectomy were given a single preoperative 2g dose of cefotetan (CTT) (52 pts) or three perioperative 2g doses of cefoxitin (CFX) plus 0.5g metronidazole (50 pts) as antibiotic prophylaxis. No statistically significant differences between the groups were detected in the clinical response (100% for both groups). The incidence of major wound infection (2% CTT and 0% CFX) were also comparable between the two treatment groups; post-operative changes in body temperature, duration of hospitalisation and post-operative urinary tract infections (16% CTT and 20% CFX) were similar. Both drugs were well tolerated. Twenty nine of the 102 patients were further investigated to determine the pharmacokinetics following a single 2g dose of CTT or CFX, in both serum and tissue. Although both antibiotics provided good concentrations during the early phase of surgery, CTT levels persisted for a longer time period. These results confirm that single dose cefotetan is equally as effective and safe as multiple dose cefoxitin plus metronidazole for prophylaxis in patients undergoing vaginal hysterectomy.

Topics: Adult; Aged; Bacteria, Aerobic; Bacteria, Anaerobic; Bacterial Infections; Cefotetan; Cefoxitin; Clinical Trials as Topic; Drug Therapy, Combination; Female; Humans; Hysterectomy; Hysterectomy, Vaginal; Metronidazole; Middle Aged; Postoperative Complications; Premedication; Random Allocation

To more clearly understand the microbiology of acute salpingitis in our patients and to evaluate the clinical efficacy and safety of recommended and new therapeutic regimens, 126 women who met clinical diagnostic criteria for acute community-acquired pelvic inflammatory disease underwent endocervical and endometrial cultures prior to random intravenous therapy with cefoxitin plus doxycycline, ceftizoxime plus doxycycline or ceftizoxime alone (two regimens). Nine women (7%) had Chlamydia, and 70 (56%) had gonococci in endometrial specimens (P less than .001). Only two women (3.4%) given monotherapy required altered medical therapy, and none required surgery. Parenteral combination therapy was associated more frequently with adverse clinical and laboratory events.

Topics: Acute Disease; Adolescent; Adult; Bacteria; Bacterial Infections; Cefoxitin; Ceftizoxime; Doxycycline; Drug Administration Schedule; Drug Therapy, Combination; Endometritis; Female; Humans; Microbial Sensitivity Tests; Prospective Studies; Random Allocation; Salpingitis; Uterine Cervicitis

Two hundred eighty-seven women were treated in a multicenter, randomized, comparative study to compare the safety and efficacy of cefotetan every 12 hours with that of cefoxitin every 6 or 8 hours in the treatment of acute obstetric and gynecologic pelvic infections. The most frequent primary diagnoses in both groups were endometritis and pelvic inflammatory disease; 24 of these patients were also bacteremic. The mean duration of treatment was 5.2 and 5.4 days for the cefotetan and cefoxitin groups, respectively, and the total doses administered were 18.1 and 32.1 gm, respectively. The rate of clinical failure for the cefotetan group was 8.5% and 12.2% for the cefoxitin group. Laboratory and clinical adverse reactions were infrequent and none was serious; both antimicrobials were well tolerated. These results suggest the administration of cefotetan provided adequate clinical and bacteriologic effectiveness in the treatment of hospital- and community-acquired, polymicrobial obstetric and gynecologic pelvic infections.

Topics: Acute Disease; Adult; Bacterial Infections; Cefotetan; Cefoxitin; Cephamycins; Clinical Trials as Topic; Cross Infection; Endometritis; Female; Genital Diseases, Female; Humans; Pelvic Inflammatory Disease; Random Allocation

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

The clinical efficacy and safety of cefotetan was assessed in two multicenter clinical trials involving 335 evaluable patients hospitalized with obstetric and gynecologic infections. In Study I, cefotetan was compared with moxalactam and in Study II, cefotetan was compared with cefoxitin. The clinical response rate in Study I was 67 of 70 patients for cefotetan (96 percent) and 33 of 34 patients (97 percent) for moxalactam. In Study II, the clinical response rate was 138 of 147 patients in the cefotetan group (94 percent) and 76 of 84 patients in the cefoxitin group (91 percent). For the patients with bacteriologic response data, 196 of 205 cefotetan patients (96 percent), 23 of 24 moxalactam patients (96 percent), and 70 of 75 cefoxitin patients (93 percent) had a satisfactory bacteriologic response. Cefotetan was well tolerated and produced no major adverse reactions. The mean amount of cefotetan given was lower than that of moxalactam or cefoxitin.

Topics: Adult; Bacterial Infections; Cefotetan; Cefoxitin; Cephamycins; Clinical Trials as Topic; Female; Genital Diseases, Female; Humans; Moxalactam; Pregnancy; Pregnancy Complications, Infectious; Random Allocation

Three broad-spectrum cephalosporins (cefotetan, moxalactam, and cefoxitin) proved effective in this randomized, prospective trial for treatment of 303 surgical patients with moderately severe regional peritonitis.

Topics: Bacterial Infections; Cefotetan; Cefoxitin; Cephamycins; Clinical Trials as Topic; Humans; Moxalactam; Peritonitis; Prospective Studies; Random Allocation; Time Factors

Because of the high incidence of beta-lactamase production among bacteria that are found commonly in pelvic infections in women, beta-lactamase-inhibiting antibiotics should prove effective in treating those infections. In a randomized, comparative study of 47 women with intraabdominal infections, 23 received ticarcillin disodium/clavulanate potassium, and 24 received cefoxitin. Among the infections treated were endometritis, pelvic inflammatory disease, amnionitis, salpingitis, septicemia, intraabdominal abscess and pelvic abscess. The bacteriologic response to ticarcillin disodium/clavulanate potassium was 88.8% success as compared with 87.5% for cefoxitin. Clinical cures were achieved in 98.8% of patients treated with ticarcillin disodium/clavulanate potassium and 90.9% of patients treated with cefoxitin. The adverse reactions were diarrhea, transient eosinophilia and transient thrombocytosis.

Topics: Adult; Bacterial Infections; beta-Lactamase Inhibitors; Cefoxitin; Clavulanic Acid; Clavulanic Acids; Clinical Trials as Topic; Drug Combinations; Endometritis; Female; Humans; Pelvic Inflammatory Disease; Penicillins; Random Allocation; Ticarcillin

In this open, prospective, comparative study, 75 patients who sustained penetrating abdominal trauma were randomised to receive 1 of 3 antibiotic regimens preoperatively and for 3 to 5 days postoperatively. Group I received cefotaxime 2g 8-hourly, group II received cefoxitin 2g 6-hourly and group III received clindamycin (900 mg 8-hourly) and gentamicin 3 to 5 mg/kg/day in divided doses 8-hourly. The 3 groups were not statistically different in terms of age, sex, severity of injury, number of organs injured, colon injuries, shock, blood transfusions or positive intra-operative cultures. Septic complications occurred in 8% of patients in group I, in 4% of group II patients and in 8% of group III patients. Cefotaxime was the least costly regimen, followed by cefoxitin, then clindamycin and gentamicin. It may be concluded that single agent therapy with a broad spectrum cephalosporin is preferable to combination therapy on the basis of equivalent effectiveness, less toxicity and lower costs.

Topics: Abdominal Injuries; Bacterial Infections; Cefotaxime; Cefoxitin; Cephalosporins; Clindamycin; Costs and Cost Analysis; Drug Therapy, Combination; Gentamicins; Humans; Prospective Studies; Random Allocation; Wounds, Penetrating

Cefotetan is a recently introduced cephamycin antibiotic for parenteral administration, with a broad spectrum of antibacterial activity. Its elimination half-life of three hours or more allows a twice-daily dosage schedule. A noncomparative trial of cefotetan yielded a satisfactory clinical response in the treatment of all of ten patients with pelvic infection. Subsequently, we did a prospective, randomized comparative study of 53 patients with pelvic infections treated with either cefotetan (2 gm IV every 12 hours) or cefoxitin (2 gm IV every six to eight hours). Both drugs showed similar clinical efficacy and antimicrobial activity (100% [n = 36] with cefotetan and 94% [n = 17] with cefoxitin, the difference not statistically significant). A mean of 21.3 gm of cefotetan was required, as compared with 34.4 gm of cefoxitin, a statistically significant difference (P less than .001). Use of cefotetan is therefore more cost effective.

Topics: Adult; Bacteria; Bacterial Infections; Cefotetan; Cefoxitin; Cephamycins; Chorioamnionitis; Endometritis; Female; Genital Diseases, Female; Humans; Microbial Sensitivity Tests; Pelvic Inflammatory Disease; Pregnancy; Pregnancy Complications, Infectious; Prospective Studies; Random Allocation

The efficacy, safety and effect of a single, 1-g dose of ceftizoxime on the return of vaginal flora were compared to those of the standard regimen of three 2-g doses of cefoxitin for prophylaxis in 99 randomized women undergoing vaginal hysterectomy. Thirty-four were studied in Dallas and 65 in Los Angeles. Surgical procedures were comparable for all the antibiotic groups, although proportionately more simple hysterectomies were performed in Dallas. The patients received a povidone-iodine vaginal preparation immediately before surgery; vaginal packs, when used, contained no antimicrobial agents. Primary prophylactic failure (operative site infection) occurred in 1 of 52 (1.9%) and 4 of 47 (8.5%) of the ceftizoxime- and cefoxitin-treated patients, respectively, for a nonsignificant difference. All five primary prophylactic failures occurred in the Los Angeles patients. One patient in each antibiotic group developed a urinary tract infection and was classified as a secondary prophylactic failure. Febrile morbidity, length of hospital stay and incidence of adverse effects did not differ by antibiotic. The enterococcus was commonly found in the postoperative vaginal flora and was of no value in predicting operative-site infection. Enterobacter species and Pseudomonas aeruginosa were isolated more commonly in patients who received cefoxitin. Diphtheroids, Staphylococcus epidermidis and Peptostreptococcus species were isolated more commonly in patients treated with ceftizoxime.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Bacterial Infections; Cefotaxime; Cefoxitin; Ceftizoxime; Drug Administration Schedule; Female; Humans; Hysterectomy; Hysterectomy, Vaginal; Postoperative Complications; Random Allocation

The present study was undertaken to determine the minimal effective antibiotic dosage in caesarean section prophylaxis. The study was conducted at the Academisch Ziekenhuis der Vrije Universiteit in Amsterdam (Amsterdam Free University Hospital) to compare the efficacy of one dose of cefoxitin (2 g) with three administrations of 2, 1 and 1 g respectively. In this prospective and double-blind study, 66 patients were given one dose and 72 patients received three doses. In terms of febrile morbidity, endometritis, wound infection, urinary tract infection and need for postoperative antibiotic therapy, the three-dose group showed fewer postoperative infections: as to wound infections (p less than 0.05) and therapeutic antibiotic use (p less than 0.025) these differences were statistically significant. The numbers of days of hospitalization after the caesarean section also showed differences: 10.6 +/- 2.6 versus 9.8 +/- 1.5 days in the one- and three-dose groups respectively (p less than 0.05). It is concluded that, contrary to several reports in the literature, prophylaxis consisting of three administrations of cefoxitin is to be preferred. No significant allergic or adverse reactions were observed in our patients.

Topics: Bacterial Infections; Cefoxitin; Cesarean Section; Clinical Trials as Topic; Double-Blind Method; Drug Administration Schedule; Female; Humans; Postoperative Complications; Pregnancy; Prospective Studies; Random Allocation; Surgical Wound Infection

The efficacy and safety of ceftizoxime and cefoxitin were compared in a randomized, double-blind study of therapy for lower extremity infections in patients with diabetes mellitus or peripheral vascular disease. Overall clinical responses were satisfactory in 82% (23/28) of patients treated with ceftizoxime and in 68% (17/25) of patients treated with cefoxitin. The difference was not statistically significant. Ceftizoxime had superior in vitro activity against Enterobacteriaceae, especially Enterobacter cloacae, whereas cefoxitin had better activity against the Bacteroides fragilis group. Relapses of infection were common in both groups during long-term follow-up; only about one third of patients in either group maintained satisfactory outcomes after one year. More than half of the patients in both groups responded to one or more courses of medical therapy and avoided major amputations for one year following entry into the study.

Topics: Aged; Bacterial Infections; Cefotaxime; Cefoxitin; Ceftizoxime; Clinical Trials as Topic; Diabetes Complications; Double-Blind Method; Female; Follow-Up Studies; Foot; Foot Diseases; Humans; Ischemia; Male; Middle Aged; Prospective Studies; Random Allocation; Recurrence

Topics: Acute Disease; Aged; Bacterial Infections; Cefotetan; Cefoxitin; Clinical Trials as Topic; Female; Humans; Male

Topics: Adult; Bacterial Infections; Cefotetan; Cefoxitin; Clinical Trials as Topic; Drug Therapy, Combination; Female; Genital Diseases, Female; Humans; Metronidazole

Preliminary results of a randomised trial comparing parenteral sulbactam 1g plus ampicillin 2g every 8 hours and cefoxitin 2g every 8 hours in 75 patients with gynaecological infection are reported. Clinical and bacteriological cure were achieved in 87% and 91% of patients treated with sulbactam/ampicillin compared with 83% and 59% treated with cefoxitin. Both treatments were well tolerated.

Topics: Adolescent; Adult; Ampicillin; Bacterial Infections; beta-Lactamase Inhibitors; Cefoxitin; Child; Clinical Trials as Topic; Drug Therapy, Combination; Endometritis; Female; Genital Diseases, Female; Humans; Penicillanic Acid; Peritonitis; Random Allocation; Salpingitis; Sulbactam

Cefoxitin, a cefamycin derivative, has demonstrated activity against a broad spectrum of aerobic and anaerobic bacterial pathogens. The efficacy and safety of cefoxitin were compared with that of the combination of clindamycin and gentamicin in the treatment of postcesarean section infection. Ninety-eight patients were evaluated. Cefoxitin cured 36 of 48 patients (75%); clindamycin/gentamicin cured 38 of 50 (76%) (P greater than .05). Febrile degree hours and length of hospital stay did not differ between the two study groups. No patient experienced abscess formation or septic pelvic thrombophlebitis. Both therapies were well tolerated. In the authors' experience, cefoxitin as a single agent was as effective in the treatment of postoperative pelvic infection as the combination of clindamycin and gentamicin.

Topics: Adult; Bacterial Infections; Cefoxitin; Cesarean Section; Clindamycin; Clinical Trials as Topic; Drug Therapy, Combination; Female; Follow-Up Studies; Gentamicins; Humans; Postoperative Complications; Pregnancy; Prospective Studies; Random Allocation; Surgical Wound Infection

The efficacy, tolerance, and safety of cefotetan--a new 7-alpha-methoxy cephalosporin--was assessed in controlled and uncontrolled evaluations involving 131 evaluable patients hospitalized with obstetric and gynecologic infections. The 99% satisfactory clinical response rate obtained with this drug was equivalent to that obtained with either moxalactam or cefoxitin, yet the mean amount of cefotetan given was lower than that of the other two drugs. Cefotetan was well tolerated and produced no major adverse reactions. In this era of Diagnosis Related Groups and cost containment, the twice-daily dosage schedule of cefotetan is a decided cost benefit.

Topics: Adult; Bacterial Infections; Cefotetan; Cefoxitin; Cephamycins; Clinical Trials as Topic; Drug Tolerance; Female; Genital Diseases, Female; Humans; Microbial Sensitivity Tests; Middle Aged; Moxalactam; Pregnancy; Pregnancy Complications, Infectious; Random Allocation

The efficacy of therapy with cefoxitin sodium plus tobramycin sulfate, with the tobramycin therapy discontinued if no cefoxitin-resistant pathogens grew from appropriate cultures, was compared with clindamycin phosphate plus tobramycin therapy in mixed aerobic/anaerobic intra-abdominal and female pelvic infections. Of 96 evaluable patients, 39 (76%) of 51 randomized to cefoxitin and 38 (84%) of 45 randomized to clindamycin were cured and an additional seven (14%) of 51 and three (6.7%) of 45, respectively, were improved. Bacteroides fragilis "group" was isolated from 44 (54%) of 82 patients with appropriate specimens. Duration of aminoglycoside therapy was significantly shorter in patients randomized to cefoxitin and tobramycin (mean, 4.1 +/- 1.8 days vs 7.0 +/- 3.2 days). There was a tendency to greater nephrotoxic reactions in patients randomized to clindamycin and tobramycin. We conclude that cefoxitin plus tobramycin with selective early discontinuation of aminoglycoside therapy is an acceptable regimen for the therapy of mixed aerobic/anaerobic infections.

Topics: Adolescent; Adult; Aged; Bacteria, Aerobic; Bacteria, Anaerobic; Bacterial Infections; Cefoxitin; Child; Child, Preschool; Clindamycin; Clinical Trials as Topic; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Prospective Studies; Random Allocation; Tobramycin

A randomized, double-blind, multicenter trial was initiated to compare the safety and efficacy of piperacillin, cephalothin and cefoxitin in the prophylactic treatment of patients undergoing vaginal hysterectomy. The total dose of each antibiotic was 6 grams given in three equally divided doses. A satisfactory prophylactic response was obtained in 143 of 151 (95 per cent) patients treated with piperacillin, in 82 of 87 (94 per cent) patients treated with cephalothin and in 57 of 60 (95 per cent) patients treated with cefoxitin. The pooled data indicated that the piperacillin treatment group did not differ from the combined cephalosporin treatment groups with respect to prophylactic response, presence of febrile morbidity, fever index, duration of postoperative hospitalization and incidence of reported adverse experiences.

Topics: Adult; Aged; Aged, 80 and over; Bacterial Infections; Cefoxitin; Cephalothin; Clinical Trials as Topic; Double-Blind Method; Female; Humans; Hysterectomy; Hysterectomy, Vaginal; Microbial Sensitivity Tests; Middle Aged; Piperacillin; Postoperative Complications; Premedication; Random Allocation

The objective of this double-blind study was to compare the efficacy and safety of piperacillin with that of cefoxitin in patients with bacterial infections. Seventy hospitalized patients were treated with intravenous piperacillin (18 g/day) or cefoxitin (12 g/day) for a mean period of 11.5 days. Multiple serious underlying conditions were present in 91% of the patients in both treatment groups. The infection sites were the respiratory, urinary, and gastrointestinal tracts, the skin and skin structures, and the bones. Among the patients with evaluated courses of therapy, 87% (20 of 23) of the patients in the piperacillin-treated group and 90% (19 of 21) of the cefoxitin-treated patients were cured or improved. Multiple sites of infection were present in 6 patients given piperacillin and in 11 patients given cefoxitin. Gram-negative aerobic bacteria were the most frequently isolated organisms (56% of isolates). In each treatment group, 91% of the pathogens were eradicated. Three piperacillin-treated patients (9%) and four cefoxitin-treated patients (11%) had adverse clinical effects related to therapy; most of the effects were moderate in intensity. In conclusion, both piperacillin and cefoxitin were clinically safe and effective antibiotics for the treatment of these patients, most of whom had severe underlying conditions.

Topics: Adult; Aged; Aged, 80 and over; Bacterial Infections; Cefoxitin; Clinical Trials as Topic; Double-Blind Method; Female; Humans; Male; Middle Aged; Piperacillin; Random Allocation

The efficacy and toxicity of moxalactam were compared with the efficacy and toxicity of cefoxitin given with or without tobramycin to 109 patients with surgical infections. A total of 66 patients could be assessed for efficacy (33 patients in each group); 13 of the cefoxitin-treated patients also received tobramycin for at least 72 h. Most patients had intraabdominal infections; 17 had peritonitis, 14 had intraabdominal abscesses, and 7 had perforation of a gangrenous appendix. There were 15 patients with necrotizing soft-tissue infections. The predominant pathogens were members of the Enterobacteriaceae and Bacteroides fragilis. The cure rates were 79% (26 of 33 patients) for moxalactam and 88% (29 of 33 patients) for cefoxitin; the difference in cure rates was not statistically significant. In several patients, cultures of purulent intraabdominal exudates were negative, although bacteria were observed after Gram staining; this presumably reflected the potent activity of the antibiotic therapy which had been started before surgical drainage could be carried out. Adverse effects were observed in 18 of 44 assessable patients (41%) in the cefoxitin group and in 12 of 36 patients (33%) in the moxalactam group; the difference in the rates of adverse effects was not statistically significant. Our results suggest that moxalactam is similar in efficacy and toxicity to cefoxitin given with or without tobramycin for the treatment of serious surgical sepsis caused by a mixture of anaerobic and aerobic pathogens.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Bacteroides fragilis; Bacteroides Infections; Cefoxitin; Drug Therapy, Combination; Enterobacteriaceae; Enterobacteriaceae Infections; Female; Humans; Male; Middle Aged; Moxalactam; Prospective Studies; Random Allocation; Surgical Wound Infection; Tobramycin

In the United States, several well-designed studies have demonstrated the efficacy of short-course antibiotic prophylaxis in cesarean sections. The present prospective study was conducted on 150 patients in a Dutch university hospital in a randomized double-blind fashion. Cefoxitin was administered according to a three-dose, 12 h regimen, the first injection given immediately after clamping of the umbilical cord. The rate of infection among the patients was significantly reduced by prophylaxis, judging from febrile morbidity, endometritis, wound infections, urinary tract infections and need for postoperative antibiotic therapy. The prophylactic use of the cefoxitin was especially effective in the secondary cesarean section population. Three risk factors significantly correlated with increased risk of infection: labor, rupture of membranes and pelvic examination. Postoperative cervical cultures showed a significant reduction of bacteria in the cefoxitin group. No shift towards resistant pathogens was demonstrable.

Topics: Adult; Bacterial Infections; Cefoxitin; Cesarean Section; Double-Blind Method; Female; Humans; Postoperative Complications; Pregnancy; Premedication; Prospective Studies; Random Allocation; Risk

A prospective, double-blind study was performed to evaluate the comparative efficacy of single- and multiple-dose antimicrobial prophylaxis for preventing infection in high-risk patients undergoing cesarean section. One hundred fifty-eight patients were randomly assigned to receive either a single perioperative dose of mezlocillin, three doses of mezlocillin or three doses of cefoxitin. The incidence of endometritis was 5.9%, 4.0% and 4.0%, respectively. The incidence of febrile morbidity was 5.9%, 2.0% and 6.1%, respectively. These differences are not statistically significant. The single perioperative dose of mezlocillin was as effective as the three-dose regimen of either mezlocillin or cefoxitin.

Topics: Adult; Bacterial Infections; Cefoxitin; Cesarean Section; Double-Blind Method; Endometritis; Female; Humans; Mezlocillin; Postoperative Complications; Pregnancy; Premedication; Prospective Studies; Random Allocation; Urinary Tract Infections

Three hundred and seven patients with appendicitis were randomized to receive cefoxitin or gentamicin and metronidazole. For early appendicitis, a single preoperative dose of antibiotics was given. For late cases, the antibiotics were continued postoperatively for seven days. Both cefoxitin and gentamicin-metronidazole were effective in the reduction of post-appendicectomy septic complications in early or late appendicitis and there was no statistically significant difference between them. Mild transient and reversible nephrotoxicity was detected in 1.9% of patients who received gentamicin-metronidazole for seven days. Nephrotoxicity was not detected in any other patients. The cost of cefoxitin is higher, but this has to be balanced against the costs of monitoring serum gentamicin and creatinine levels, and the need to adjust the gentamicin dosage in 19% of patients when gentamicin-metronidazole was used. Both cefoxitin and gentamicin-metronidazole are effective and safe when used carefully. Cefoxitin has a slight advantage in its lack of potential nephrotoxicity and ototoxicity.

Topics: Adolescent; Adult; Appendectomy; Appendicitis; Bacterial Infections; Cefoxitin; Drug Therapy, Combination; Female; Gentamicins; Humans; Male; Metronidazole; Middle Aged; Premedication; Prospective Studies; Random Allocation

Topics: Bacterial Infections; Cefoxitin; Cesarean Section; Clinical Trials as Topic; Double-Blind Method; Endometritis; Female; Humans; Mezlocillin; Pregnancy; Premedication; Prospective Studies; Random Allocation; Surgical Wound Infection; Ureaplasma

A double-blind, placebo-controlled trial was performed to assess the value of cefoxitin for prophylaxis against postoperative infection following radical hysterectomy. Infectious morbidity was observed in 35% of 43 patients in the control group and 23% of 31 in the cefoxitin group. In seven control patients (16%) and one patient (3%) in the cefoxitin group the infections were related to the surgical site (p = 0.07). These differences did not achieve statistical significance. Examination of the data revealed a number of other factors, including operating time, patient weight, blood loss, and blood replacement, that were significantly related to the incidence of infectious morbidity. Comparison of the results of the present study with those in the literature indicates that a careful examination of the circumstances prevailing in any particular institution is necessary before a decision is made on strategies to combat infectious morbidity after radical hysterectomy.

Topics: Adult; Bacterial Infections; Cefoxitin; Clinical Trials as Topic; Double-Blind Method; Female; Humans; Hysterectomy; Length of Stay; Middle Aged; Postoperative Complications; Premedication; Surgical Wound Infection

Twenty-three patients (22 male and 1 female) aged 41 to 70 years (mean age 56.4 years) with cancer of the upper respiratory and digestive tracts were entered into the study prior to a major surgical procedure involving incision of cervical mucous membranes. Participants were randomly assigned either to a control group (10 patients) which received no routine intra or postoperative antibiotics, or to a treatment group (13 patients) given cefoxitin perioperatively. Treated patients were given 30 mg/kg cefoxitin intravenously over 30 mn, one hour before surgery was begun, and 30 mg/kg over one hour, 3 hours and 6 hours after the initial infusion was started. Rate of local infection was 80% (8/10) and 15% (2/10) in the control group and treated group respectively (p less than 0.001). In addition, a significant difference in rates of local complications was found: 7 disjunctions and/or fistulae or pharyngostomes in the control group against one suppuration with disjunction in the treated group. In the treated group, a mean 24.6 day reduction in time lapse to cicatrization was observed. Fever greater than or equal to 39 degrees C occurring or persisting beyond the 48th postoperative hour was also significantly more frequent in the control group (7/10 versus 3/13). In contrast, no significant difference was found between rates of other infectious localizations. Local bacterial flora recovered in both groups before and/or after surgery was unremarkable and prophylactic cefoxitin selected no particular pathogens.

Topics: Adult; Aged; Bacterial Infections; Cefoxitin; Digestive System Neoplasms; Drug Evaluation; Female; Humans; Male; Middle Aged; Postoperative Complications; Respiratory Tract Neoplasms

Fifty women were randomly given one, two, or three 2 gm parenteral doses of cefoxitin with placebo blinding perioperatively at abdominal hysterectomy. A single preoperative intramuscular dose was more efficient, less frequently associated with the development of bacterial resistance, and less expensive than two or three doses.

Topics: Bacterial Infections; Cefoxitin; Clinical Trials as Topic; Double-Blind Method; Drug Resistance, Microbial; Female; Humans; Hysterectomy; Postoperative Complications; Premedication

Piperacillin has been shown to be as safe and effective an agent as cephalothin and cefoxitin when used in patients undergoing elective intra-abdominal surgical procedures. Enterococcus species have been shown in other studies to be susceptible to piperacillin, perhaps making it the preferred antibiotic for prophylaxis in clinical settings when enteric flora will be encountered.

Topics: Abdomen; Bacterial Infections; Cefoxitin; Cephalothin; Clinical Trials as Topic; Double-Blind Method; Drug Evaluation; Female; Humans; Male; Piperacillin; Postoperative Complications; Preoperative Care; Surgical Wound Infection

In a prospective, randomized, single-blind trial, we studied 112 adults with intra-abdominal infections and compared antibiotic therapy with cefoxitin plus placebo to therapy with tobramycin plus clindamycin. Seventy-five percent of patients receiving tobramycin-clindamycin and 71% of those receiving cefoxitin-placebo had either shock, bacteremia, malnutrition, alcoholism, rapidly or ultimately fatal underlying disease, infection originating from the distal small bowel or colon, or had had failed therapy before treatment ("high-risk" group). One third of the patients in both groups grew bacteria in the initial culture resistant to the antibiotic regimen used. Ten patients receiving cefoxitin-placebo (17%) and 11 receiving tobramycin-clindamycin (21%) had recurrence of infection or died of infection (clinical failures). Nineteen failures occurred in high-risk patients (p less than 0.05) and 17 were in patients that had antibiotic-resistant bacteria in the initial culture (p less than 0.01). Adverse effects were rare and remitted after antibiotics were stopped. Our results suggest that both cefoxitin and tobramycin-clindamycin are appropriate antibiotic regimens to treat intra-abdominal infections. Clinical failure is more common in high-risk patients and when antibiotic-resistant organisms are isolated from initial cultures.

Topics: Adult; Alcoholism; Bacterial Infections; Cefoxitin; Clindamycin; Clinical Trials as Topic; Drug Resistance, Microbial; Drug Therapy, Combination; Enterobacteriaceae; Humans; Intestinal Diseases; Nutrition Disorders; Prospective Studies; Random Allocation; Risk; Tobramycin

Pelvic infections represent the most feared complications associated with vaginal and abdominal hysterectomy. In the present paper we show result of a prospective randomized clinical trial carried out to study different morbidities (F.M. febrile morbidity, U.T.I. urinary tract infections, P.C. pelvic cellulitis, P.A. pelvic abscess, W.I. wound infection) in a sample of 155 patients undergoing vaginal or abdominal hysterectomy for non malignant disease, divided into three groups. group C, treated with 2 g cefoxitin i.v. in the preoperative period; group C+T, the same treatment with the addition of T tube suction drainage; group T, with only the T tube suction drainage. A statistical analysis of the sample showed the homogeneity of each group, while the study of the morbidities showed a statistical significant difference for W.I. between the groups treated with antibiotic and the T group (p less than .001). For all the other morbidities, no statistically significant differences were found between the groups, demonstrating that all three methods are considerably efficient in reducing postoperative morbidity in hysterectomy.

Topics: Bacterial Infections; Cefoxitin; Clinical Trials as Topic; Female; Humans; Hysterectomy; Hysterectomy, Vaginal; Premedication; Prospective Studies; Random Allocation; Suction

In a prospective randomized trial on 77 patients undergoing elective colorectal surgery, cefoxitin and cephalothin were given as systemic antibiotic prophylaxis. Postoperative sepsis occurred in 2/40 (5%) of those given cefoxitin compared to 9/37 (24.3%) of those given cephalothin. The reduction in the infection rate in the group treated by cefoxitin was statistically significant (p less than 0.02). Specific drug toxicity was not evidenced except for transient skin rashes in two patients of both groups.

Topics: Aged; Bacterial Infections; Cefoxitin; Cephalothin; Clinical Trials as Topic; Colon; Female; Humans; Male; Middle Aged; Premedication; Prospective Studies; Random Allocation; Rectum

A trial of cefoxitin was performed on 25 children needing urgent and accurate antibiotic therapy before laboratory test results could be made available. Cefoxitin proved to be highly active in the treatment of infections of bacterial origin. It was therefore found suitable for use in the clinical situation where the urgency of the need for treatment differs from theoretical practice.

Topics: Bacterial Infections; Cefoxitin; Child; Child, Preschool; Clinical Trials as Topic; Drug Evaluation; Emergencies; Female; Humans; Infant; Injections, Intramuscular; Male

Major surgery of the cancers of the upper aerodigestive tract involves a high risk of post operative infection. We report the results of a clinical controlled trial aimed to evaluate the effectiveness and the cost of the prevention of post operative infections by peri operative cefoxitin. These results show a significant difference in favor of the treated group when considering the local infection rate (15% versus 80%) the length of healing, as well as the direct costs related to the antibiotherapy. These results have been confirmed by a further study.

Topics: Adult; Aged; Bacterial Infections; Cefoxitin; Clinical Trials as Topic; Cost-Benefit Analysis; Female; Humans; Laryngeal Neoplasms; Male; Middle Aged; Mouth Neoplasms; Pharyngeal Neoplasms; Premedication

Ninety-three female patients with post-cesarean endometritis, post-hysterectomy pelvic cellulitis, and other miscellaneous moderately severe pelvic soft-tissue infections were treated in a randomized fashion with either ticarcillin plus clavulanic acid or cefoxitin. Of the 47 patients treated with ticarcillin plus clavulanic acid, 38 had clinical cures, four showed improvement, therapy failed in three, and two were nonevaluable, for a failure rate of 6.7 percent. Of the 46 patients treated with cefoxitin, 33 had clinical cures, five showed improvement, therapy failed in seven, and one was nonevaluable, for a failure rate of 15.6 percent. Bacteriologically, the addition of clavulanic acid to ticarcillin was found to broaden the antibacterial spectrum to include some Escherichia coli, most Klebsiella, many coagulase-negative staphylococci, and all isolates of Staphylococcus aureus. Adverse reactions were few, with only one patient having therapy with cefoxitin discontinued because of side effects. It is concluded that ticarcillin plus clavulanic acid is quite suitable for antibiotic therapy of female pelvic soft-tissue infection, based on the (expanded) coverage of both aerobic and anaerobic bacterial species.

Topics: Adolescent; Adult; Bacterial Infections; Cefoxitin; Cellulitis; Clavulanic Acid; Clavulanic Acids; Drug Combinations; Endometritis; Female; Humans; Middle Aged; Pelvic Inflammatory Disease; Penicillins; Ticarcillin

Ninety patients at the Wilmington Medical Center were enrolled in a comparative study to evaluate the efficacy and toxicity of ticarcillin plus clavulanic acid in the treatment of a variety of infections. Forty-seven women with obstetric or gynecologic infections were randomly assigned to receive ticarcillin plus clavulanic acid or cefoxitin. Forty-three patients with gram-negative septicemia or lower respiratory tract infection were given ticarcillin plus clavulanic acid or tobramycin plus piperacillin in a randomized fashion. Of the 47 women with obstetric or gynecologic infections, 23 were randomly assigned to receive ticarcillin plus clavulanic acid, and 24 were randomly assigned to receive cefoxitin. Several patients in each group had underlying diseases such as diabetes, obesity, and hypertension. Of the 27 pathogens isolated in the group receiving ticarcillin plus clavulanic acid, 26 (96 percent) were eradicated, including all three ticarcillin-resistant pathogens. In the cefoxitin-treated group, 31 of the 33 (94 percent) pathogens were eliminated, including all four ticarcillin-resistant organisms. Three reinfections or superinfections occurred, and cefoxitin therapy failed to eliminate an enterococcus isolate from the endometrium in one patient. The clinical response in both treatment groups was excellent. Either cure or clinical improvement was achieved for all 18 sites of infection in the ticarcillin plus clavulanic acid-treated group and for all 22 sites in the cefoxitin-treated group. There were no systemic drug reactions in either treatment group. In one patient in the cefoxitin-treated group, local phlebitis developed at the infusion site. This reaction responded to local therapy. There were no local reactions among the patients receiving ticarcillin plus clavulanic acid. Of the 43 patients with gram-negative septicemia or lower respiratory tract infection, 21 were randomly assigned to receive ticarcillin plus clavulanic acid and 22 were assigned to receive tobramycin plus piperacillin. Thirty-six patients had gram-negative sepsis, and seven patients had lower respiratory tract infection. Nine of the 36 patients suspected of having gram-negative sepsis were not evaluable because no pathogen was isolated prior to treatment. Twenty-two of the 27 patients treated for septicemia had good clinical and microbiologic responses. Three of the seven patients with pneumonia were not evaluable. Of the four evaluable patients, two had pneumococcus pneum

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefoxitin; Clavulanic Acid; Clavulanic Acids; Drug Combinations; Female; Gram-Negative Bacteria; Hospitalization; Humans; Male; Penicillins; Piperacillin; Respiratory Tract Infections; Sepsis; Ticarcillin; Tobramycin

In a randomized, single-blind study, the efficacy of single-dose cefotaxime was compared with multiple dose cefoxitin in genitourinary surgery prophylaxis. Patients received either 1.0 g cefotaxime before surgery; or 2.0 g cefoxitin pre-operatively and every 8 h for no more than 24 h post-operatively. Of the evaluable patients receiving cefotaxime 3 of 35 (8.6%) became infected post-operatively, compared to 12 of 37 (32.4%) patients receiving cefoxitin (P less than 0.01). It is concluded that single-dose genitourinary surgical prophylaxis with cefotaxime may be more effective than a longer dosing schedule with cefoxitin in the prevention of post-operative urinary tract infections, and that a single-dose regimen may represent significant cost containment advantages for hospitals.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Cefoxitin; Female; Humans; Male; Middle Aged; Postoperative Complications; Premedication; Urogenital System

Fifty-nine patients with serious infections were assigned at random in a two-to-one ratio to receive either cefmenoxime or cefoxitin given intravenously in a dosage of 0.5 to 2.0 g every six hours. Of 44 patients evaluable for efficacy, eight had concomitant bacteremia and all but 10 had serious underlying disease. The average duration of therapy was seven days. All patients with skin and soft tissue infections were cured after treatment with either antibiotic. Cefmenoxime achieved clinical and bacteriologic cures in 92 and 83 percent, respectively, of 12 patients with pneumonia and in 100 and 82 percent of 11 patients with urinary tract infections. Cefoxitin therapy resulted in clinical and bacteriologic cures in all four patients with pneumonia. Among 10 patients with urinary tract infection, respective cure rates were 90 and 50 percent. Both antibiotics were well tolerated. One cefmenoxime-treated patient discontinued treatment because of a rash.

Topics: Adult; Bacterial Infections; Cefmenoxime; Cefotaxime; Cefoxitin; Drug Administration Schedule; Drug Evaluation; Female; Humans; Infusions, Parenteral; Male; Random Allocation; Respiratory Tract Infections; Skin Diseases, Infectious; Urinary Tract Infections

A comparative study was conducted using cefmenoxime, a new extended spectrum cephalosporin, versus cefoxitin. Entry into the study was based on a computer-generated randomization (two cefmenoxime to one cefoxitin). An intravenous dose of cefmenoxime (0.5 to 1 g every six hours) or cefoxitin (1 to 2 g every six hours) was administered to patients suspected of having serious bacterial infections. Six patients had urinary tract infections. Four who received cefmenoxime, including two with positive blood cultures, had eradication of bacteremia. One of the two who received cefoxitin had significant bacteriuria, and the urine was clear after treatment. Twenty-four patients were treated for lower respiratory tract infections. All 15 patients who received cefmenoxime had clinical and bacteriologic cures. Two of the nine patients who received cefoxitin continued to have the pathogens at the end of the treatment period. Both patients had a neoplasm of the lung. All 11 patients who had soft tissue infections (nine of whom received cefmenoxime) responded well. Both antibiotics were well tolerated.

Topics: Bacterial Infections; Cefmenoxime; Cefotaxime; Cefoxitin; Clinical Trials as Topic; Humans; Random Allocation; Respiratory Tract Infections; Urinary Tract Infections

One hundred one women undergoing elective abdominal hysterectomy were given perioperative cefoperazone or cefoxitin in a prospective randomized blinded study. Both regimens were well tolerated and no significant toxic or allergic manifestations were observed. Interrelationships between antimicrobial concentration in serum and pelvic tissues, intraoperative cardinal ligament cultures, febrile morbidity, and major postoperative infection were determined. At uterine removal, mean cefoperazone concentrations in serum (56.1 micrograms/mL) and pelvic tissues (18.6 micrograms/g) were significantly higher than mean concentrations of cefoxitin, ie, 16.1 micrograms/mL and 8.1 micrograms/g, respectively (P less than .001). The incidence of major postoperative infection was 6% or less with both regimens. Perioperative prophylaxis significantly reduced the incidence of this infection. When it did develop, however, it continued to cause significant morbidity, prolonging hospital stay a mean of more than four days (P less than .001) and increasing the hospital bill a mean of almost $1500 (P less than .001).

Topics: Adult; Bacterial Infections; Cefoperazone; Cefoxitin; Clinical Trials as Topic; Female; Fever; Humans; Hysterectomy; Middle Aged; Postoperative Complications; Premedication; Prospective Studies; Random Allocation

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefoxitin; Clinical Trials as Topic; Female; Humans; Male; Middle Aged

In this randomized, double-blind study, the effectiveness of a single-agent prophylactic antibiotic in reducing infections after radical abdominal hysterectomy with pelvic and para-aortic lymphadenectomy was compared with a placebo. A total of 12 doses of cefoxitin (2g) or placebo were given to 70 patients, starting the evening before surgery. Because of tumor spread beyond the cervix, radical hysterectomy was not performed in 17 patients who were, therefore, excluded from the study. Analysis of 53 patients who completed the study revealed that 15% of cefoxitin patients had surgical site-related infections compared with 52% of placebo patients (P = .005). Significant differences between the groups were also observed in nonsurgical site-related infections (23 versus 48%), overall morbidity (58 versus 89%), and the need for additional antibiotic therapy (38 versus 67%). Socioeconomic status was a significant risk factor with 57% of staff patients demonstrating increased site-related infections as compared with 17% of private patients (P = .002). No clinically significant side effects were observed. The authors recommend the use of antibiotic prophylaxis in patients undergoing radical abdominal hysterectomy for gynecologic malignancies.

Topics: Adult; Aged; Anti-Bacterial Agents; Bacterial Infections; Cefoxitin; Clinical Trials as Topic; Double-Blind Method; Female; Humans; Hysterectomy; Lymph Node Excision; Middle Aged; Pneumonia; Postoperative Complications; Premedication; Random Allocation; Risk; Socioeconomic Factors; Surgical Wound Infection; Urinary Tract Infections

To identify the risk factors for the development of postoperative septic complications in patients with intestinal perforation after abdominal trauma, and to compare the efficacies of single-drug and dual-drug prophylactic antibiotic therapy, we studied 145 patients who presented with abdominal trauma and intestinal perforation at two hospitals between July 1979 and June 1982. Logistic-regression analysis showed that a higher risk of infection (P less than 0.05) was associated with increased age, injury to the left colon necessitating colostomy, a larger number of units of blood or blood products administered at surgery, and a larger number of injured organs. The presence of shock on arrival, which was found to increase the risk of infection when this factor was analyzed individually, did not add predictive power. Patients with postoperative sepsis were hospitalized significantly longer than were patients without infection (13.8 vs. 7.7 days, P less than 0.0001). Both treatment regimens--cefoxitin given alone and clindamycin and gentamicin given together--resulted in similar infection rates, drug toxicity, duration of hospitalization, and costs.

Topics: Abdominal Injuries; Adult; Age Factors; Bacterial Infections; Blood Transfusion; Cefoxitin; Clindamycin; Colon; Drug Therapy, Combination; Female; Gentamicins; Humans; Intestinal Perforation; Male; Prospective Studies; Risk; Shock, Traumatic; Wound Infection; Wounds, Penetrating

Piperacillin sodium (Pipracil, Lederle Laboratories, Wayne, New Jersey), a new semisynthetic penicillin, demonstrated in vitro activity against a broad spectrum of clinical pathogens. It is active against most strains of the clinically important gram-negative aerobic or facultative bacteria and against virtually all the clinically important anaerobic organisms, including Bacteroides fragilis and Bacteroides bivius. This broad antibacterial spectrum suggested that piperacillin might be an effective single antimicrobial agent for the treatment of mixed aerobic/anaerobic infections in obstetric and gynecologic patients. In this study, the clinical efficacy and safety of piperacillin was compared with that of cefoxitin in the management of pelvic infections. There were 23 patients in the piperacillin group (acute salpingitis, 12; endomyometritis, 7; pelvic cellulitis, 2; tuboovarian abscess, 2) and 25 patients in the cefoxitin group (acute salpingitis, 13; endomyometritis, 10; tuboovarian abscess, 2). An average of six bacteria were isolated from each patient. Aerobic bacteria only were recovered from 12.5%, anaerobic bacteria only in 6.5%, and both aerobic and anaerobic bacteria were present in 82.5% of patients. Overall, 21 of 23 (91%) of the piperacillin treatment group and 23 of 25 (92%) of the cefoxitin group responded to therapy with antimicrobial agents alone. The major cause of failure was the presence of an abscess. Piperacillin was shown to be an effective single agent for the management of pelvic infections caused by mixed aerobic and anaerobic bacteria. In addition, piperacillin proved to be safe and well tolerated.

Topics: Adolescent; Adult; Bacterial Infections; Cefoxitin; Clinical Trials as Topic; Female; Genital Diseases, Female; Humans; Middle Aged; Penicillins; Piperacillin; Pregnancy

In a randomized comparative trial, 45 patients were treated with amdinocillin plus cefoxitin or cefoxitin alone for bacterial soft tissue infections. Most patients were diabetic and had polymicrobial foot infections. The combination of amdinocillin plus cefoxitin was active in vitro against 71 percent of the isolates obtained before therapy as compared with 65 percent for cefoxitin alone. The combination demonstrated synergy for 29 percent of the isolates tested. A satisfactory clinical response occurred in 90 percent and 71 percent of patients treated with the combination regimen and cefoxitin, respectively, (p greater than 0.1). An increase in serum creatinine thought to be due to interstitial nephritis occurred in one patient treated with the combination regimen. The combination of amdinocillin and cefoxitin was effective in mixed soft tissue infections including diabetic foot infections.

Topics: Adult; Aged; Amdinocillin; Bacterial Infections; Cefoxitin; Connective Tissue Diseases; Diabetes Complications; Drug Evaluation; Drug Therapy, Combination; Female; Humans; Injections, Intravenous; Male; Microbial Sensitivity Tests; Middle Aged; Penicillanic Acid; Random Allocation

A randomized double-blind placebo-controlled comparison of prophylactic cefoxitin, an antibiotic with good activity against anaerobic bacteria, with cefazolin, an agent effective predominantly against aerobes, was undertaken in 354 women who underwent nonelective cesarean section (124 receiving cefoxitin, 119 cefazolin, and 111 placebo). Among the placebo group, 24.3% developed genital tract-related infection, in comparison to 5.6% of the cefoxitin patients and 6.7% of the cefazolin patients (P less than 0.001). Standard febrile morbidity, fever index, and duration of postoperative hospital stay were also significantly less in the antibiotic prophylactic groups. For patients with febrile morbidity, the mean fever index was less in the cefoxitin group (24.8 degree-hours) than that in the cefazolin group (42.7 degree-hours), and this difference approached statistical significance (P less than 0.1, greater than 0.05). Postoperative hospital stay longer than 1 week for infectious morbidity occurred in 26% of cefoxitin patients, a significantly lower incidence compared to the 66% rate for patients who received cefazolin, and the 57% incidence for patients in the placebo group (P less than 0.05).

Topics: Adult; Bacterial Infections; Cefazolin; Cefoxitin; Cesarean Section; Clinical Trials as Topic; Double-Blind Method; Female; Fever; Genital Diseases, Female; Humans; Infant, Newborn; Length of Stay; Postoperative Complications; Pregnancy; Premedication; Random Allocation

A double-blind, randomized study of gentamicin and netilmicin, each in combination with cefoxitin, was done to compare their respective efficacy and toxicity in patients with serious systemic infection. Thirty-seven surgical patients were evaluated for efficacy and 46 patients were evaluated for toxicity. The most frequently cultured organisms were Escherichia coli (15), Klebsiella sp (9), Proteus sp (6), and Bacteroides sp (4). For 23 patients treated with gentamicin-cefoxitin (G-C), the clinical response was favorable in 20/21 (95.2%) evaluable cases, and elimination or marked reduction of 33/34 (97.1%) organisms was achieved. For 14 patients treated with netilmicin-cefoxitin (N-C), the clinical response was favorable in 13/13 (100%) evaluable cases, and 19/20 (95%) organisms were eliminated or markedly reduced. Nephrotoxicity was defined as an increase in serum creatinine to greater than 25% over baseline with an absolute rise of at least 0.5 mg/100 ml to a value greater than or equal to 1.3 mg/100 ml. Based on these criteria, nephrotoxicity was seen in 2/27 (7.4%) patients treated with G-C and in 3/19 (15.8%) patients treated with N-C. Ototoxicity was defined as a greater than 20 dB loss at any frequency. Based on these criteria, ototoxicity was seen in 5/27 (18.5%) patients treated with G-C and 2/19 (10.5%) patients treated with N-C. The data show no significant difference in toxicity and suggest that netilmicin and gentamicin are both highly effective in combination with cefoxitin in patients who have serious infections after surgery.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Bacteroides Infections; Cefoxitin; Clinical Trials as Topic; Double-Blind Method; Drug Therapy, Combination; Enterobacteriaceae Infections; Female; Gentamicins; Hearing; Humans; Male; Middle Aged; Netilmicin; Random Allocation; Surgical Wound Infection; Vestibular Function Tests

The efficacy, toxicity, microbiology and pharmacology of cefoxitin and mezlocillin were compared in a clinical and laboratory study. In 81 patients treated with cefoxitin and 83 treated with mezlocillin, clinical and bacteriological cures were achieved in 79.2% and 85.5% respectively. Both antibiotics were effective in the treatment of septicaemia, pulmonary infections, urinary tract infections, intra-abdominal and pelvic infections and skin and soft-tissue infections. Both were also effective in the treatment of anaerobic infections. No major haematological, hepatic, or renal toxicity was encountered in patients treated with either drug.

Topics: Adolescent; Adult; Aged; Bacteria; Bacterial Infections; Cefoxitin; Clinical Trials as Topic; Double-Blind Method; Female; Humans; Male; Mezlocillin; Middle Aged

The effectiveness of antibiotic irrigation in reducing post-cesarean section infectious morbidity was studied in a prospective, randomized, double-blind trial. One hundred twenty-eight patients were divided into three groups and irrigated with either cefoxitin solution, cephapirin solution, or saline. Following delivery of the placenta, the uterine cavity and incision, bladder flap, pelvic gutters, and subcutaneous tissue of the patients were irrigated. There was a significant reduction in total infectious morbidity (p less than 0.02) and wound infection (p less than 0.04) when antibiotic use was compared to the saline control. No statistical difference in the effectiveness of the two antibiotics could be demonstrated. No adverse effects were noted. Antibiotic irrigation is a safe and effective method in reducing infectious morbidity of the parturient patient.

Topics: Bacterial Infections; Cefoxitin; Cephalosporins; Cephapirin; Cesarean Section; Clinical Trials as Topic; Double-Blind Method; Female; Humans; Intraoperative Care; Postoperative Complications; Pregnancy; Prospective Studies; Random Allocation; Surgical Wound Infection; Therapeutic Irrigation

A retrospective chart analysis of women undergoing elective abdominal hysterectomy in Parkland Memorial Hospital indicated significant postoperative antibiotic administration. For that reason, we conducted a prospective, double-blind, placebo-controlled study to determine the incidence of infection and febrile morbidity in this patient population and to evaluate the efficacy of perioperative cefoxitin in modifying the incidence of these conditions. Three 2 gm intramuscular doses of cefoxitin over 12 hours significantly reduced the incidence of major infection to 12% from 32% observed in the placebo group. The mean hospital stay for women given cefoxitin (5.6 days) was also significantly reduced when compared to that for women given placebo (6.4 days). The incidence of febrile morbidity not requiring therapy was significant and was not altered by perioperative cefoxitin. Febrile morbidity was observed in 42% of women given cefoxitin and in 34% of women given placebo. Administration of perioperative antimicrobial agents is necessary for women undergoing elective abdominal hysterectomy in our hospital, but we believe that individual determination is required.

Topics: Adolescent; Bacterial Infections; Cefoxitin; Cellulitis; Clinical Trials as Topic; Double-Blind Method; Female; Fever; Humans; Hysterectomy; Length of Stay; Pelvic Inflammatory Disease; Postoperative Complications; Premedication; Prospective Studies; Random Allocation

Topics: Adult; Aged; Bacterial Infections; Cefoxitin; Clinical Trials as Topic; Female; Humans; Injections, Intravenous; Male; Middle Aged; Respiratory Tract Infections; Urinary Tract Infections

In a prospective randomized trial clinical results of orthograde bowel lavage alone (group I) versus combined bowel lavage and parenteral antibiotic prophylaxis with 4 gm Cefoxitin (group II) in two separate dosages (perioperative short-term-prophylaxis) are compared with regard to the reduction of septic complications after colorectal surgery. Septic wound complications were 11/27 = 41% in group I and 2/30 = 7% in group II. The rate of anastomotic leakages was significantly different in the two groups (5/27 in group I, 0 in group II). The monetary costs for given antibiotics and the duration of hospitalization were less in group II. Orthograde bowel lavage alone proved to be of no effect in reducing the rate of septic complications when used without antibiotic perioperative short-term-prophylaxis and therefore cannot be recommended to be used solely.

Topics: Aged; Bacterial Infections; Cefoxitin; Female; Humans; Intestine, Large; Male; Middle Aged; Premedication; Prospective Studies; Surgical Wound Infection; Therapeutic Irrigation

Topics: Adult; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Cefoxitin; Clinical Trials as Topic; Female; Humans; Mezlocillin; Pelvic Inflammatory Disease; Penicillins; Pneumonia; Skin Diseases, Infectious; Urinary Tract Infections

The results of three consecutive clinical trials on the therapy of anaerobic infections in cancer patients have been compared. The success rate with lamoxactam (94%) (6000mg/d i.v.) was statistically different from that of doxycycline (63%) (300 mg/d per os). Clindamycin (1200 mg/d per os), clindamycin (2700 mg/d i.v.) and cefoxitin (6000 mg/d i.v.) resulted in a favourable outcome in approximately 80% of the patients. Mixed anaerobic infections had a similar response rate (80%). Even when the anaerobic pathogen was resistant to therapy, six of ten patients were cured. Surgical drainage played an important role, but was difficult to assess precisely.

Topics: Anti-Bacterial Agents; Bacterial Infections; Cefoxitin; Cephamycins; Clindamycin; Clinical Trials as Topic; Doxycycline; Drainage; Female; Humans; Male; Middle Aged; Moxalactam; Neoplasms; Retrospective Studies; Tinidazole

The Authors illustrate the results obtained in treatment of various types of infection in patients hospitalised in an intensive care surgical department with cephoxitin, a new semisynthetic antibiotic derivate of the cephalosporin group. In view of the severity of the treated cases, the Authors consider the results obtained to be satisfactory.

Topics: Adult; Aged; Bacterial Infections; Cefoxitin; Clinical Trials as Topic; Cross Infection; Female; Humans; Intensive Care Units; Male; Middle Aged; Postoperative Complications; Respiratory Tract Infections; Surgical Wound Infection; Urinary Tract Infections

Ninety patients infected with presumed penicillin resistant anaerobes were randomized to cefoxitin or clindamycin-aminoglycoside. Cefoxitin was comparable to clindamycin-aminoglycoside in cures of intestinal associated, 16 of 26 versus 11 of 21, and pelvic infections, 20 of 20 versus 22 of 23. Cefoxitin-resistant facultative-aerobic gram-negative rods were found in 16 of 45 patients with intestine associated infection. Probable antibiotic associated nephrotoxicity was less frequent in the patients in the cefoxitin group, zero of 46 versus seven of 44, p less than 0.05, although a false creatinine elevation was noted more frequent, seven of 46 versus one of 44, p less than 0.05. Infections causing failure in patients in the cefoxitin group more frequently contained cefoxitin resistant gram-negative rods at the time of failure than did infections causing failure in those in the clindamycin-aminoglycoside group that contained gentamicin-resistant gram-negative rods, eight of eight versus zero of eight, p less than 0.001. Cefoxitin may be adequate therapy for many patients with mixed anaerobic/aerobic infections; however, the addition of an aminoglycoside may be prudent in those with known, or suspected, cefoxitin resistant gram-negative rods.

Topics: Adolescent; Adult; Aminoglycosides; Bacterial Infections; Cefoxitin; Clindamycin; Clinical Trials as Topic; Drug Resistance, Microbial; Female; Genital Diseases, Female; Humans; Intestinal Diseases; Male; Prospective Studies; Random Allocation

This prospective study was designed to compare the relative efficacy of two antibiotic regimens for the treatment of operative site infections subsequent to pelvic operations. Patients with endomyoparametritis after delivery or pelvic cellulitis subsequent to hysterectomy were randomized to treatment with the combination of penicillin-gentamicin or the single agent cefoxitin. Seventeen of the 26 patients (65%) with endomyoparametritis who were treated with penicillin-gentamicin were cured by antibiotic therapy alone, in comparison to 15 of 23 (65%) patients treated with cefoxitin. Fifty-eight percent of the patients with pelvic cellulitis who were treated with penicillin-gentamicin responded favorably, in comparison to 50% of the patients treated with cefoxitin. None of these differences was statistically significant. In this study, neither antibiotic regimen provided satisfactory initial treatment for surgically induced soft tissue pelvic infection. Moreover, 11 of the 28 patients with treatment failures (40%) developed serious sequelae of their primary infection.

Topics: Bacterial Infections; Cefoxitin; Cesarean Section; Clindamycin; Clinical Trials as Topic; Delivery, Obstetric; Drug Therapy, Combination; Endometritis; Female; Gentamicins; Humans; Hysterectomy; Infant, Newborn; Parametritis; Penicillins; Peptococcus; Postoperative Complications; Pregnancy; Prospective Studies; Puerperal Infection; Staphylococcal Infections; Streptococcus agalactiae

Cefoxitin was administered parenterally in doses of 2 g, every six hours for two days, to 20 patients undergoing colorectal surgery. Blood and fecal specimens were obtained for five days for analysis of cefoxitin concentrations. Tissue samples from the gut wall were obtained at surgery. The maximum serum concentrations during surgery varied between 25 and 100 microgram/ml, and the cefoxitin concentrations for the fecal samples were 1.5-35 microgram/g and for the tissue samples, 2.0-50 microgram/g. Fecal samples for cultivation of aerobic and anaerobic bacteria were also obtained daily during the first five days, and after 14 day after operation. Pronounced changes in the microflora occurred during the investigation period. Among the aerobic bacteria, cefoxitin-sensitive Escherichia coli and other enterobacteria decreased markedly while cefoxitin-resistant enterococci, Pseudomonas and Enterobacter proliferated during the antibiotic prophylaxis period. Among the anaerobic bacteria, Bacteroides fragilis and other Gram-negative bacteria decreased significantly. However, after the antibiotic administration period, all cefoxitin-resistant strains decreased while the suppressed E. coli and B. fragilis strains increased. In one patient, a minor postoperative infection caused by a cefoxitin-resistant strain of Pseudomonas aeruginosa was observed.

Topics: Adult; Aged; Anaerobiosis; Bacteria; Bacterial Infections; Cefoxitin; Clinical Trials as Topic; Colon; Female; Humans; Male; Middle Aged; Postoperative Complications; Premedication; Preoperative Care; Rectum

The efficacy of cefoxitin, either alone or in combination (+/-) with an aminoglycoside was compared with clindamycin plus (+), an aminoglycoside for the treatment of mixed aerobic-anaerobic surgical infections, in a prospective randomized single blinded study. One hundred patients were entered into the study; 37 patients were assessable for clinical outcome in both groups, while toxicity could be assessed in 46 patients in the cefoxitin group and 47 in the clindamycin group. The groups were evenly matched considering age, sex, and type of infection. Favorable clinical responses were achieved in 34 of 37 patients treated with cefoxitin +/- amikacin, and 29 of 37 patients treated with clindamycin + amikacin; there was no statistical difference between the groups (p greater than 0.1). The incidences of toxicity were the same. Our study has demonstrated that cefoxitin with or without an aminoglycoside is as effective as clindamycin plus an aminoglycoside in the therapy of serious mixed infections in surgical patients.

Topics: Adolescent; Adult; Aged; Amikacin; Bacterial Infections; Cefoxitin; Clindamycin; Clinical Trials as Topic; Drug Therapy, Combination; Female; Humans; Kanamycin; Male; Middle Aged; Postoperative Complications; Prospective Studies

A double-blind, controlled trial was performed to assess the effect of a short intraoperative course of Cefoxitin, a new broad spectrum cephamycin antibiotic, on the incidence of septic complications following elective colonic and rectal surgery. In addition to a two-day preoperative bowel preparation, patients entered in the study received a short course of either Cefoxitin (three 2g intravenous bolus doses at two-hour intervals, the first before skin incision) or a matching placebo. Thirty-two patients received Cefoxitin and 33 patients received the placebo. Postoperative abdominal wound infections developed in one (3%) of the Cefoxitin-treated patients and nine (27%) of the placebo-treated patients. This difference is statistically significant (p = 0.01). Septic complications remote from the abdominal wound, e.g. intra-abdominal abscesses, occurred in both Cefoxitin-treated and placebo-treated patients, but numbers were too small for meaningful analysis. The study shows that even a very short peroperative course of Cefoxitin is highly effective in reducing postoperative abdominal wound infections after elective colorectal surgery.

Topics: Adult; Aged; Bacterial Infections; Cefoxitin; Clinical Trials as Topic; Colon; Double-Blind Method; Female; Humans; Intraoperative Period; Male; Middle Aged; Postoperative Complications; Premedication; Rectum; Surgical Wound Infection

A total of 19 pediatric patients received cefoxitin for the treatment of various infections by intravenous injections of a daily dose ranging from 68 to 125 mg/kg body weight dividing the dose into 3 to 4 times per day. The therapeutic efficacy was excellent in 14 cases, good in 4 and fair in 1, the efficacy rate being 95%. As for side effects, 1 case each of rash, diarrhea and eosinophilia were observed, but none of them were serious.

Topics: Age Factors; Bacterial Infections; Cefoxitin; Child; Child, Preschool; Clinical Trials as Topic; Female; Humans; Infant; Injections, Intravenous; Male

Forty-eight patients who underwent elective hip or knee surgery were randomly divided into two groups. A total of 22 patients received a single 1-g preoperative bolus of cefoxitin, and 26 patients received a single 1-g preoperative dose of cephalothin. At various time intervals, serum and bone samples were taken during the operative procedure. Our data indicated that whereas serum levels of cefoxitin and cephalothin were maintained for at least 2h at levels capable of inhibiting most gram-positive cocci and many gram-negative rods, bone levels of cefoxitin rather rapid decay over a 2-h period. Moreover, in only 58% of the entire cephalothin-treated group were bone levels detectable and then only at a concentration that would inhibited gram-positive cocci. No significant morbidity was observed in either treatment group.

Topics: Bacterial Infections; Bone and Bones; Cefoxitin; Cephalothin; Clinical Trials as Topic; Double-Blind Method; Hip; Humans; Knee; Orthopedics; Surgical Wound Infection

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

The costs of cefoxitin sodium therapy and clindamycin phosphate plus amikacin sulfate therapy for mixed aerobic-anaerobic infections were compared. A randomized, prospective study was undertaken with 70 adult patients with documented or suspected serious aerobic-anaerobic infections. It had been shown that the two therapies did not differ in efficacy or incidence of toxicity. The cost to the pharmacy for one day's therapy was chosen as the unit of cost comparison. Cost-per-day data were calculated by the unit-price and price-allocation methods with and without a sterile-products charge. Amikacin was added to the cefoxitin regimen when resistant organisms were cultured. To extend the analysis to other aminoglycosides, rough comparisons were made for "equivalent" doses of tobramycin sulfate and gentamicin sulfate. Fifty-four patients completed the trial (77%). The cost of cefoxitin therapy was significantly less than that of clindamycin plus amikacin therapy and cefoxitin plus amikacin therapy (p less than 0.001) by both pricing methods. When gentamicin and tobramycin were substituted for amikacin sulfate, the cost per day for therapy, according to the price-allocation method, was still significantly less for cefoxitin (p less than 0.001). Cost analysis is an important component in the selection of the appropriate therapy after the efficacy and toxicity of therapeutic regimens have been shown to be equivalent.

Topics: Aerobiosis; Amikacin; Anaerobiosis; Anti-Bacterial Agents; Bacterial Infections; Cefoxitin; Clindamycin; Costs and Cost Analysis; Gentamicins; Humans; Tobramycin

Topics: Adult; Aged; Bacteria; Bacterial Infections; Cefoxitin; Clinical Trials as Topic; Drug Resistance, Microbial; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged

Clindamycin and cefoxitin with or without gentamicin were administered to cancer patients having localized infections presumably caused by anaerobic pathogens. The rates of favorable response were 89% in patients receiving clindamycine alone and 78% in patients receiving cefoxitin alone. When the total experience is considered (clindamycin or cefoxitin with and without gentamicin), 20 of 24 patients (83%) responded to clindamycin and 18 of 22 (82%) responded to cefoxitin. Both therapies were well tolerated. Clindamycin was found to be more effective than cefoxitin in eradicating the offending anaerobic pathogens from the site of infection. Aerobic pathogens were frequently isolated along with anaerobes from the infectious sites in this series; their susceptibility or resistance to clindamycin or cefoxitin did not influence the therapeutic response.

Topics: Anaerobiosis; Bacterial Infections; Cefoxitin; Clindamycin; Female; Humans; Male; Middle Aged; Neoplasms

Intravenous cefazolin and cefoxitin were compared in a prospective randomized trial in infections where the suspected pathogen was expected to be susceptible to both antibiotics. In the cefazolin group (12 patients) the diagnosis was pneumonia in 4, including 2 with pneumococcal bacteremia, soft tissue infection in 5, Staphylococcus aureus bacteremia in 1, acute pyelonephritis in 1, and disseminated gonococcal infection in 1. In the cefoxitin group (10 patients) the diagnosis was pneumonia in 4, including 2 with pneumococcal bacteremia, soft tissue infection in 4, acute pyelonephritis in 1, and disseminated gonococcal infection in 1. In the cefazolin group receiving an evaluable course of therapy, a good clinical response was seen in 10 of 11 patients, and a bacteriological response was seen in 5 of 7. Cefazolin failed to eradicate S. aureus bacteremia in 1 patient and S. aureus in a skin ulcer of another patient. All 10 cefoxitin patients had good clinical and bacteriological responses, but in 1 patient S. aureus colonization of a postoperative wound recurred after discontinuation of the drug. Side effects in both groups included skin rash, phlebitis, and elevation of the serum alkaline phosphatase. Both cefoxitin and cefazolin appeared effective in infections caused by susceptible aerobic pathogens with the possible exception of S. aureus, although all 11 strains of S. aureus isolated in this study were susceptible in vitro to both antibiotics. Cefoxitin appeared to be equivalent to cefazolin in efficacy and occurrence of side effects.

Topics: Adult; Aerobiosis; Aged; Bacterial Infections; Cefazolin; Cefoxitin; Cephalosporins; Clinical Trials as Topic; Female; Humans; Male; Middle Aged; Prospective Studies

Since the introduction of cephalothin and cephaloridine as the first parenteral cephalosporins and cephalexin as the first member of the group which is absorbed from the gastrointestinal tract, several new cephalosporin derivatives have been developed. Most of these have no major advantages over cephalothin, cephaloridine or cephalexin. Increased knowledge about the importance of beta-lactamases for bacterial resistance against beta-lactam antibiotics has focused interest on development of drugs with increased resistance to degradation by these enzymes. Among the caphalosporins, cefamandole and cefuroxime have been found to be markedly more active against beta-lactamase producing Gram-negative bacteria. A new group of beta-lactam antibiotics, the cephamycins, have been introduced with cefoxitin as the first clinically useful member. Cefoxitin has the spectrum of a beta-lactamase-resistant cephalosporin and is also active against Bacteroides fragilis. The review concentrates on the antibacterial spectrum of these three new antibiotics and on their clinical efficacy.

Topics: Bacteria; Bacterial Infections; Cefamandole; Cefoxitin; Cephalosporinase; Cephalosporins; Cephamycins; Clinical Trials as Topic; Drug Evaluation; Drug Resistance, Microbial; Furans; Humans; Penicillinase

Topics: Aged; Bacterial Infections; Cefoxitin; Cephalosporins; Cephalothin; Clinical Trials as Topic; Humans; Middle Aged

Topics: Adult; Aged; Bacterial Infections; Cefoxitin; Cephalosporins; Clinical Trials as Topic; Humans; Middle Aged

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefoxitin; Cephalosporins; Child; Clinical Trials as Topic; Drug Therapy, Combination; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Respiratory Tract Infections; Sepsis; Urinary Tract Infections

Topics: Abdomen; Adolescent; Adult; Aged; Bacterial Infections; Cefoxitin; Cephalosporins; Clinical Trials as Topic; Female; Humans; Kinetics; Male; Microbial Sensitivity Tests; Middle Aged

Topics: Abdomen; Adult; Aged; Bacterial Infections; Cefoxitin; Cephalosporins; Clinical Trials as Topic; Female; Humans; Male; Middle Aged; Postoperative Complications

Topics: Abdomen; Adolescent; Adult; Aged; Bacterial Infections; Cefoxitin; Cephalosporins; Child; Child, Preschool; Clinical Trials as Topic; Female; Humans; Infant; Male; Middle Aged

Topics: Adult; Aged; Bacterial Infections; Cefoxitin; Cephalosporins; Child; Clinical Trials as Topic; Drug Interactions; Female; Humans; Male; Middle Aged; Probenecid; Time Factors

Topics: Adult; Aged; Bacterial Infections; Cefoxitin; Cephalosporins; Clinical Trials as Topic; Female; Humans; Immunosuppression Therapy; Male; Middle Aged

Topics: Adolescent; Adult; Aged; Bacteria; Bacterial Infections; Cefoxitin; Cephalosporins; Cephalothin; Child; Clinical Trials as Topic; Drug Resistance, Microbial; Humans; Microbial Sensitivity Tests; Middle Aged; Time Factors

Topics: Bacterial Infections; Cefoxitin; Cephalosporins; Clinical Trials as Topic; Humans

Topics: Adult; Aged; Anaerobiosis; Bacterial Infections; Cefoxitin; Cephalosporins; Cephalothin; Clinical Trials as Topic; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Respiratory Tract Infections

Topics: Adult; Anaerobiosis; Bacterial Infections; Cefoxitin; Cephalosporins; Clinical Trials as Topic; Female; Humans; Liver Abscess; Lung Abscess; Male; Osteomyelitis

Topics: Arthritis; Bacterial Infections; Cefoxitin; Cephalosporins; Clinical Trials as Topic; Empyema, Tuberculous; Endocarditis, Bacterial; Humans; Lung Abscess; Osteomyelitis; Pneumonia; Sepsis; Urinary Tract Infections

Topics: Adult; Bacterial Infections; Cefazolin; Cefoxitin; Cephalosporins; Clinical Trials as Topic; Humans; Middle Aged

Topics: Bacterial Infections; Cefoxitin; Cephalosporins; Clinical Trials as Topic; Humans; Injections, Intramuscular; Injections, Intravenous

Topics: Adolescent; Adult; Aged; Bacteria; Bacterial Infections; Cefoxitin; Cephalosporins; Cephalothin; Clinical Trials as Topic; Female; Humans; Infusions, Parenteral; Male; Middle Aged

Topics: Aerobiosis; Anaerobiosis; Bacterial Infections; Cefoxitin; Cephalosporins; Clinical Trials as Topic; Humans; Infusions, Parenteral; Injections, Intramuscular

Topics: Bacterial Infections; Bacteroides fragilis; Bacteroides Infections; Cefoxitin; Cephalosporins; Clinical Trials as Topic; Female; Genital Diseases, Female; Humans; Injections, Intravenous; Pregnancy; Pregnancy Complications, Infectious

Topics: Aerobiosis; Anaerobiosis; Bacterial Infections; Cefoxitin; Cephalosporins; Clinical Trials as Topic; Female; Genital Diseases, Female; Humans; Injections, Intravenous; Pregnancy; Pregnancy Complications, Infectious

Cefoxitin was administered intravenously to 143 patients, 67% of whom were seriously ill. The rate of cure or improvement was 93%. The study was conducted in two phases; the first was an open, controlled clinical comparison of cefoxitin and cephalothin. In this phase, 28 patients received cefoxitin and 29 received cephalothin. In the second phase, cefoxitin alone was used for the treatment of an additional 115 patients. Twenty bacteremic patients treated with cefoxitin were cured or improved in 95% of cases. The infecting organism was eradicated in all bacteremic patients. All of 14 anaerobic or predominantly anaerobic infections were cured or improved. The infecting anaerobic organism was eliminated in 86% of the cases. Twenty-five patients infected by cephalothin-resistant, cefoxitin-susceptible gram-negative rods were cured. Three patients each with infective endocarditis and osteomyelitis were cured. The incidence of adverse experiences was: 1.4% drug eruption; 2% each asymptomatic serum transaminase elevation and leukopenia; and 2.5% asymptomatic eosinophilia. The incidence of severe thrombophlebitis was 5%. No permanent or serious adverse reactions were encountered. Although the numbers of patients in some categories were too small to permit statistical evaluation, I feel that cefoxitin may be a useful new antibiotic for treatment of infections caused by cehalothin-resistant bacteria and by anaerobic organisms.

Topics: Adult; Bacterial Infections; Cefoxitin; Cephalosporins; Cephalothin; Clinical Trials as Topic; Drug Resistance, Microbial; Endocarditis, Bacterial; Humans; Osteomyelitis; Sepsis

The novel bicyclic penem inhibitor BLI-489 has demonstrated activity as an inhibitor of class A, C, and D beta-lactamases. To determine the combination of piperacillin and BLI-489 to be used in susceptibility testing that would most accurately identify susceptible and resistant isolates, a predictor panel of beta-lactamase-producing bacteria was utilized to determine the reliability of the combination of piperacillin-BLI-489 at a constant inhibitor concentration of 2 or 4 microg/ml and at ratios of 1:1, 2:1, 4:1, and 8:1. There were a number of strains that would be falsely reported as susceptible or intermediate if tested with the ratios of 1:1 and 2:1, whereas the constant concentration of 2 microg/ml of BLI-489 and the ratio of 8:1 had a tendency to overpredict resistance. Similar MICs were obtained with piperacillin-BLI-489 in a 4:1 ratio and when BLI-489 was held constant at 4 microg/ml. Based on these results, an in vitro testing methodology employing a constant concentration of 4 microg/ml BLI-489 was used to evaluate the combination of piperacillin-BLI-489 against a larger panel of recently identified clinical isolates. Approximately 55% of all of the enteric bacilli tested were nonsusceptible to piperacillin alone (MIC > or = 32 microg/ml). However, 92% of these piperacillin nonsusceptible strains were inhibited by < or =16 microg/ml piperacillin-BLI-489; in contrast, only 66% were inhibited by < or =16 microg/ml piperacillin-tazobactam. The combination of piperacillin-BLI-489 also demonstrated improved activity compared to that of piperacillin-tazobactam against the problematic extended-spectrum beta-lactamase- and AmpC-expressing strains.

Topics: Anti-Bacterial Agents; Bacteria; Bacterial Infections; beta-Lactamase Inhibitors; Drug Combinations; Enzyme Inhibitors; Humans; Lactams; Microbial Sensitivity Tests; Piperacillin

To describe a case of cefazolin-induced leukopenia in a critically ill patient who developed this adverse reaction upon rechallenge with cefoxitin.. A 22-year-old male was admitted after a motor vehicle crash. beta-Lactam therapy was initiated with vancomycin, cefepime, and metronidazole and, upon identification of methicillin-sensitive Staphylococcus aureus bacteremia 4 days later, therapy was narrowed to cefazolin 1 g every 12 hours. The dose was adjusted to 1 g every 12 hours during continuous venovenous hemodialysis. Imipenem was given for 2 days, resulting in a total of 18 days of beta-lactam treatment, at which time he developed significant leukopenia (white blood cell [WBC] count 0.9 x 10(3)/microL). Antimicrobial treatment was changed to tigecycline and continued for suspected pleural space infection. The patient's WBC count recovered within 4 days after the change in therapy. He was taken to surgery 8 days after cefazolin was discontinued and received perioperative prophylaxis with cefoxitin (total dose 3 g). Subsequently, the patient again became severely leukopenic (WBC count 2.4 x 10(3)/microL). Within a week after surgery, the patient developed septic shock secondary to multidrug-resistant Escherichia coli bacteremia and died.. beta-Lactam-induced leukopenia is a rare but well-described adverse drug reaction. It is a cumulative dose-dependent phenomenon reported to occur most often after 2 weeks of therapy. The mechanism of leukopenia is thought to be secondary to either an immune-mediated response or direct bone marrow toxicity. Rechallenge with a different beta-lactam antibiotic has not been shown to consistently cause recurrent leukopenia. The case described here suggests an immune-related mechanism for the development of leukopenia. Use of the Naranjo probability scale determined the association between cephalosporin use and leukopenia to be probable.. Cefazolin was a probable cause of this patient's leukopenia. It is important for clinicians to recognize beta-lactam-induced leukopenia and maybe recommend use of a drug from a different antibiotic class if continued treatment is indicated.

Topics: Adult; Anti-Bacterial Agents; Bacterial Infections; Cefoxitin; Humans; Leukocyte Count; Leukopenia; Male

Susceptibilities to 16 antimicrobial agents were determined by measurement of MICs for 344 isolates of anaerobic bacteria recovered from patients with significant infections. Resistance rates varied among antimicrobial agents and the species tested. The beta-lactams were more active in gram-positive than in gram-negative anaerobes. Resistance to meropenem was low (<1%). For beta-lactam-beta-lactamase inhibitors, piperacillin-tazobactam was most active for all species (resistance, <6%). The rates of resistance to cefoxitin (31 to 65%) and clindamycin (50 to 70%) for non-Bacteroides fragilis species of the B. fragilis group were higher than those for B. fragilis (4% resistant to cefoxitin and 33% resistant to clindamycin). Among members of B. fragilis group, Bacteroides thetaiotaomicron was the most resistant to clindamycin (70%) and cefoxitin (65%). Rates of susceptibility to imipenem and metronidazole for B. fragilis continue to be high compared to those from a previous study 10 years ago. However, resistance to metronidazole was found recently in five strains of B. fragilis. We analyzed the genetic relationships among the metronidazole-resistant B. fragilis strains by pulsed-field gel electrophoresis. The metronidazole-resistant B. fragilis strains showed genotypic heterogeneity, excluding the dissemination of a single clone.

Topics: Anti-Bacterial Agents; Bacteria, Anaerobic; Bacterial Infections; Bacteroides; Bacteroides fragilis; Cefoxitin; Cephamycins; Clindamycin; DNA, Bacterial; Drug Resistance, Microbial; Metronidazole; Microbial Sensitivity Tests; Taiwan; Time Factors

Topics: Antibiotic Prophylaxis; Bacterial Infections; Cefoxitin; Drug Administration Schedule; Family; Humans; Intestine, Small; Living Donors; Postoperative Complications; Transplantation, Homologous; Vancomycin

Pretreatment of tissue by using antibiotics is a critical step to prevent microbial contamination before venous transplantation. In this study, the optimal time and temperature of antibiotic solution treatment for maintaining cellular viability with antibacterial effect were investigated. The antibiotic-nutrient solutions were composed of cefoxitin, lincomycin, vancomycin, and polymyxin B in RPMI-1640 medium. After various antibiotic solution treatment times (4, 8, and 12 h) and temperatures (4, 25, and 37 degrees C), the viabilities of cells dissociated from veins (jugular vein, femoral vein, superior vena cava, and inferior vena cava) were determined. Double staining by Griffonia simplicifolia agglutins-fluorescein isothiocyanate (GS1-FITC) and propidium iodide was used. To measure the antibacterial effect of the antibiotic solution, canine veins were artificially infected by 3 kinds of bacteria (Staphylococcus aureus, Escherichia coli, and Klebsiella pneumoniae) and were treated by antibiotic solutions as viability test conditions. After the treatment with the antibiotic solution, the tissue was minced, and the homogenized tissue fraction was cultured on standard method agar. The colony that seemed to be resistant to the antibiotic solution was counted. At 37 and 25 degrees C, the viability of whole cells decreased significantly Asymptotic Significance 2-tailed (Asymp.Sig 2-tailed) < 0.05 after 4 h of antibiotic solution treatment, whereas at 4 degrees C it began to reduce significantly after 8 h of treatment. By antibiotic solution treatment at all 3 temperatures for 4 h, no significant difference in viability of the endothelial cells and whole cells was observed. To maintain the donor vein's cellular viability until transplantation, antibiotic solution treatment for 4 h at 4 degrees C is assumed to be appropriate.

Topics: Animals; Anti-Bacterial Agents; Bacterial Infections; Cefoxitin; Dogs; Endothelium, Vascular; Lincomycin; Polymyxin B; Solutions; Statistics, Nonparametric; Vancomycin; Veins

Topics: Animals; Anti-Bacterial Agents; Bacterial Infections; Cefoxitin; Drainage; Drug Carriers; Escherichia coli Infections; Humans; Liposomes; Peritonitis

We studied the in vitro activity of cefminox (MIC by agar dilution) and cefoxitin against 477 facultative Gram-positive and Gram-negative isolates which were recovered from clinical specimens and identified by standard methods. Cefminox has proved to be 4-16 times more active than cefoxitin against enteric Gram-negative bacilli commonly involved in cholecystitis, secondary peritonitis, intraabdominal abscesses and gynecological infections. On the contrary, cefoxitin has proved to be four times more active against Gram-positive cocci. Both have been ineffective against Enterobacter spp., Pseudomonas aeruginosa and Acinetobacter spp. The microbiological activity and pharmacokinetic parameters of cefminox make it one of the first choice treatments for community-acquired intraabdominal and pelvic infections with the presence of anaerobes.

Topics: Bacterial Infections; Cefoxitin; Cephamycins; Humans

Toward the completion of elective colorectal operations, 75 patients had qualitative aerobic and anaerobic cultures of specimens obtained from peritoneal irrigation fluid, anastomoses sites, and abdominal wound irrigation fluid to determine if a correlation exists between intraoperative flora and postoperative infectious complications. Patients enrolled in this prospective study received a mechanical bowel prep and a 12-18 hour course of perioperative intravenous antibiotics. Comparisons were made between the 60 (80%) patients who had no postoperative infections and the 15 (20%) who developed postoperative infectious complications (9 wound infections, 6 intraabdominal infections). There were significantly more low anterior resections in patients who developed postoperative infection compared to those who had no postoperative infection (26% vs 2%), while there were more colocolostomies in the group with no infections (38% vs 7%). Streptococcus spp., Bacteroides fragilis group, and Escherichia coli were the most commonly isolated organisms from each of the three sites sampled. Isolation of > or = 3 organisms from incisional wound cultures (P = 0.017) and < or = 4 organisms from peritoneal irrigation (P = 0.009) or anastomotic culture (P = 0.004) correlated with development of postoperative infectious complications. Thus, patients with infectious complications had significantly more isolates than those without infectious complications, and were more likely to have had a low anterior resection. These data suggest that future clinical studies should reexamine the duration of perioperative antimicrobials based on early laboratory reports of qualitative and quantitative operative site bacteriology.

Topics: Abdomen; Adolescent; Adult; Aged; Anti-Bacterial Agents; Bacteria, Aerobic; Bacteria, Anaerobic; Bacterial Infections; Cefotetan; Cefoxitin; Colonic Diseases; Digestive System; Elective Surgical Procedures; Female; Humans; Male; Middle Aged; Premedication; Prospective Studies; Rectal Diseases; Surgical Wound Infection

The comparative efficacies of cefoxitin, cefotetan and the combination of ampicillin with sulbactam were investigated in mixed aerobic and anaerobic infections of mice. Treatment was administered by intramuscular injection for 10 days and was started 1 h before infection. After intraperitoneal infection with Escherichia coli, Bacteroides fragilis, and one other member of the B. fragilis group (either Bacteroides thetaiotaomicron, Bacteroides ovatus or Bacteroides distasonis), 41 of 90 (46%) control mice died and all survivors developed polymicrobial abscesses. Cephalosporin therapy reduced mortaligy 13% with cefoxitin, 3% with cefotetan, and 23% with ampicillin plus sulbactam; 14%, 10% and 14% of surviving animals, respectively developed abscesses. Each of the treatment regimens significantly reduced the number of all organisms in abscesses, independent of their activity in vitro. However, the reduction in the number of E. coli by ampicillin plus sulbactam was less marked (P < 0.001) than that achieved by cefoxitin (P < 0.05) or cefotetan. These data show that in vivo efficiencies of cefoxitin and cefotetan, are independent of their in vitro potencies in the early management of polymicrobial infections in mice.

Topics: Ampicillin; Animals; Bacterial Infections; Cefotetan; Cefoxitin; Drug Therapy, Combination; Male; Mice; Mice, Inbred C3H; Microbial Sensitivity Tests; Sulbactam

The distributions of radiolabelled free cefoxitin (FC) and liposome-encapsulated cefoxitin (LC) were compared in an animal model of intra-abdominal sepsis. Intraperitoneally administered LC was initially retained in the peritoneal cavity with subsequent preferential drug targeting to the liver (14% injected LC) and spleen (6% injected LC) by 3 h post-injection. Differing patterns of liposomal drug and lipid retention indicated that drug release from the liposome complex occurred within the peritoneum, liver and spleen. Intraperitoneal FC was rapidly taken up into the systemic circulation, with peak recovery in the blood (9% injected FC) and liver (5% injected FC) at 1 h post-injection. FC was also rapidly eliminated; 7% of the injected drug was recovered in the kidney 1 h post-injection. A negligible amount of FC was recovered in the spleen and very little FC or LC was found in the lungs of treated animals. Unlike FC, LC was found to provide a sustained bactericidal drug level (> 40 micrograms mL-1) in the peritoneal fluid for up to 5 h post-injection. LC also achieved significantly higher drug levels, compared with FC, within the liver at 3 and 5 h post-injection. Since severe intra-abdominal sepsis is often characterized by the presence of intraphagocytic bacteria in hepatic and splenic reticuloendothelial systems, the enhanced delivery of liposome-encapsulated anti-microbial agents, such as cefoxitin, to the liver and spleen may provide a more effective treatment for the septic condition.

Topics: Abdomen; Animals; Bacterial Infections; Bacteroides fragilis; Bacteroides Infections; Cefoxitin; Drug Carriers; Drug Compounding; Enterococcus faecalis; Escherichia coli Infections; Freeze Drying; Gram-Positive Bacterial Infections; Injections, Intraperitoneal; Liposomes; Male; Rats; Rats, Sprague-Dawley; Tissue Distribution

Topics: Bacteria, Anaerobic; Bacterial Infections; Bacteroides; Bacteroides Infections; Cefotetan; Cefoxitin; Drug Resistance, Microbial; Humans; In Vitro Techniques; Microbial Sensitivity Tests

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

Topics: Anti-Bacterial Agents; Bacteria, Anaerobic; Bacterial Infections; Cefoxitin; Clindamycin; Drug Therapy, Combination; Hydrogen-Ion Concentration; Imipenem; Metronidazole; Microbial Sensitivity Tests; Penicillanic Acid; Piperacillin; Tazobactam

One of the major complications of diabetes mellitus is the occurrence of diabetic foot infection. The polymicrobial nature of diabetic foot infection has been well documented in the literature. In order to avoid amputation of the tissue affected, the ulceration and infection must be appropriately diagnosed and treated. This paper describes the microbiologic and clinical features obtained from 100 consecutive diabetic infected foot patients treated with either cefoxitin or ampicillin/sulbactam.

Topics: Ampicillin; Bacteria, Aerobic; Bacteria, Anaerobic; Bacterial Infections; Cefoxitin; Diabetic Angiopathies; Foot; Foot Ulcer; Humans; In Vitro Techniques; Microbial Sensitivity Tests; Sulbactam

There is limited information regarding the correlation of anaerobic susceptibility testing and outcome in the treatment of Bacteroides fragilis infections. We retrospectively analyzed the clinical outcomes of B. fragilis infections in patients treated with cefoxitin; the analysis was blinded for susceptibility results. Isolates of B. fragilis were tested by multiple agar dilution methods, disk elution, and commercial broth microdilution methods. Of 19 patients analyzed, 11 were cured and 8 were treatment failures. No significant differences existed between the groups with respect to age, sex distribution, weight, APACHE II score, dose of cefoxitin, or bacteremia. Failure was associated with a longer cefoxitin dosing interval (P = 0.019), a longer duration of hospitalization (P = 0.038), and decreased duration of cefoxitin treatment (P = 0.05). Four agar dilution systems (brucella plus blood, Wilkins-Chalgren, Wilkins-Chalgren plus blood, brain heart infusion plus blood) and two broth systems (Wilkins-Chalgren microdilution and a commercial system [Micromedia; Beckman, Carlsbad, Calif.]) all demonstrated lower geometric mean MICs for isolates from the group of patients that could be cured. Only the commercial broth microdilution medium (Micromedia) demonstrated a significantly reduced geometric mean MIC (P = 0.056). By using a logistic regression analysis, the shorter cefoxitin dosing interval (P = 0.0004) and the lower geometric mean MIC (P = 0.0088) in the commercial broth microdilution system were shown to be independent predictors of treatment success. These data suggest that the time that the concentration of cefoxitin is over the MIC for B. fragilis may be an important predictor of treatment success.

Topics: Adult; Bacterial Infections; Bacteroides fragilis; Cefoxitin; Female; Humans; Length of Stay; Male; Microbial Sensitivity Tests; Middle Aged; Predictive Value of Tests; Prognosis; Retrospective Studies

Several factors, including uncontrolled inflammation, gut barrier failure, and sepsis, have been implicated in the development of multiple organ failure. To investigate the relative importance and interrelationships among some of these factors, increasing doses of the inflammatory agent zymosan were used to induce a systemic inflammatory state in mice. At nonlethal doses (0.1 and 0.5 mg/g body weight), zymosan caused injury to the intestinal mucosa, increased intestinal xanthine oxidase activity, and promoted bacterial translocation in a dose-dependent fashion. Inhibition or inactivation of xanthine oxidase activity was effective in reducing mucosal injury and bacterial translocation when zymosan was injected at 0.1 mg/g but not at 0.5 mg/g body weight. At a dose of 1 mg/g, the lethal effects of zymosan appeared to be related to gut-origin sepsis, since cefoxitin (1 mg/g) reduced the seven-day mortality rate from 100% to 20% (p less than 0.01). However, at a zymosan dose of 2 mg/g, antibiotics did not improve survival. Zymosan thus induced gut barrier failure and systemic infection in a dose-dependent fashion. Additionally, the mechanism of zymosan-induced bacterial translocation and the relationship of gut-origin sepsis to survival appeared to be related to the magnitude of the inflammatory insult (the dose of zymosan).

Topics: Allopurinol; Animals; Bacteria; Bacterial Infections; Bacterial Physiological Phenomena; Cefoxitin; Colony Count, Microbial; Dose-Response Relationship, Drug; Female; Inflammation; Intestines; Liver; Male; Mice; Tungsten; Xanthine Oxidase; Zymosan

A drug utilization review program of cefoxitin was conducted in a 714-bed teaching hospital. Health records of all 43 in-patients who received cefoxitin during the month of November 1987 were reviewed retrospectively. The use of cefoxitin (47 courses) was evaluated on the basis of "appropriate use" criteria developed from the literature and the physician's clinical experience. Of the 47 courses evaluated, cefoxitin was prescribed for prophylaxis in 47%, and its use was considered inappropriate in 86% of these. Overall, 66% of total cefoxitin usage was deemed inappropriate in this hospital. The cost associated with inappropriate use was estimated at $2672 for the period of the study. Corrective measures were then implemented to rectify the identified problems. A second study was conducted 2 years later to assess the impact of the corrective measures. This utilization review program of cefoxitin showed that optimal use of a drug requires not only close collaboration between pharmacists and physicians but a continuous and not a sporadic process of surveillance of the prescription for the drug being studied.

Topics: Bacterial Infections; Cefoxitin; Costs and Cost Analysis; Creatinine; Drug Utilization; Hospitals, Teaching; Humans; Obstetrics and Gynecology Department, Hospital; Practice Patterns, Physicians'; Quebec; Retrospective Studies; Surgery Department, Hospital; Time Factors; Utilization Review

Use of decision analysis in the formulary evaluation of the second-generation cephamycin derivatives cefoxitin, cefotetan, and cefmetazole is described. The rating system used was adapted from one used for the third-generation cephalosporins. Data on spectrum of activity, pharmacokinetics, adverse reactions, cost, and stability were taken from the published literature and the FDA-approved product labeling. The weighting scheme used for the third-generation cephalosporins was altered somewhat to reflect the more important aspects of the cephamycin derivatives and their potential role in surgical prophylaxis. Sensitivity analysis was done to assess the variability of the final scores when the assigned weights were varied within a reasonable range. Scores for cefmetazole and cefotetan were similar and did not differ significantly after sensitivity analysis. Cefoxitin scored significantly lower than the other two drugs. In the absence of data suggesting that the N-methyl thiotetrazole side chains of cefmetazole and cefotetan cause substantial toxicity, these two drugs can be considered the most cost-efficient members of the second-generation cephamycins.

Topics: Bacterial Infections; Cefmetazole; Cefotetan; Cefoxitin; Cephamycins; Decision Support Techniques; Drug Costs; Drug Stability; Formularies, Hospital as Topic; Humans; Pharmacy Service, Hospital

Topics: Bacteria, Aerobic; Bacteria, Anaerobic; Bacterial Infections; Cefoxitin; Humans

Anaerobic isolates from patients with intra-abdominal infection were tested in vitro by eight methods for susceptibility to cefoxitin. Broth disk elution correlated poorly with clinical outcome. The clinical breakpoint for anaerobic susceptibility to cefoxitin was less than or equal to 32 micrograms/ml.

Topics: Adult; Aged; Bacteria, Aerobic; Bacteria, Anaerobic; Bacterial Infections; Cefoxitin; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Outcome and Process Assessment, Health Care

In an unanesthetized "treated" model of severe hemorrhagic shock, a bacteremia originating from the animal's enteric flora was demonstrated by finding radiolabeled Escherichia coli in the blood as early as 2 hr after the onset of shock. In 50 patients admitted to our trauma unit, the observation was similar, with 56% positive blood cultures, when their mean arterial blood pressure was 80 mmHg or less. The relationship of bacterial translocation and the high post-shock mortality in our conventional (CV) animal model is being evaluated in germfree (GF) Sprague-Dawley rats. Preliminary observations in 15 GF animals showed 80% survival at 24 hr post-shock, 54% at 48 hr, and 42% at 72 hr compared with those of CV animals in previous experiments with survival at similar times of 73%, 20% and 7%, respectively.

Topics: Animals; Bacterial Infections; Blood; Blood Pressure; Body Temperature; Cefoxitin; Dogs; Fluid Therapy; Germ-Free Life; Intestines; Reference Values; Shock, Hemorrhagic; Survival Analysis; Wounds and Injuries

Protein binding, serum kinetics and minimum inhibitory concentrations (MICs) for Staphylococcus aureus were determined for cefoxitin, cefazolin, ceftazidime and ceftriaxone in the rabbit. MICs of cefazolin and cefoxitin were also measured for Escherichia coli. Varying concentrations of the bacteria were administered intradermally to create areas of cellulitis, which were quantified as mean erythematous areas (EAs). Despite large differences in protein binding of the antibiotics (range 12-88%) and antibiotic dosing to allow serum concentrations to drop below the respective MICs, there was no statistical difference in the mean EAs of the animals after bacterial challenge. Antibiotic protein binding did not alter the course of cellulitis nor correlate with bacterial MIC in this model.

Topics: Animals; Bacterial Infections; Biological Availability; Cefazolin; Cefoxitin; Ceftazidime; Ceftriaxone; Cephalosporins; Chromatography, High Pressure Liquid; Escherichia coli Infections; Female; Kinetics; Protein Binding; Rabbits; Staphylococcal Infections

Topics: Bacterial Infections; Boston; Cefotetan; Cefoxitin; Drug Utilization; Hospitals, Teaching; Humans

Topics: Abdominal Pain; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Cefotetan; Cefoxitin; Clinical Trials as Topic; Humans; Microbial Sensitivity Tests; Moxalactam

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacterial Infections; Cefotetan; Cefoxitin; Colonic Diseases; Controlled Clinical Trials as Topic; Digestive System Surgical Procedures; Elective Surgical Procedures; Humans; Rectal Diseases; Surgical Wound Infection

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacterial Infections; Cefotetan; Cefoxitin; Cervix Uteri; Female; Humans; Hysterectomy, Vaginal; Middle Aged; Randomized Controlled Trials as Topic; Surgical Wound Infection; Vagina

Topics: Adult; Aged; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacterial Infections; Cefoxitin; Female; Humans; Male; Middle Aged; Perioperative Care; Randomized Controlled Trials as Topic; Vascular Surgical Procedures

Infections after oesophageal surgery are studied on sixty patients who received perioperatively two antibiotics (cefoxitin and amikacin). Postoperative infection rate is 62% (pneumopathies: 27%, leakage of cervical anastomoses: 17%). Different parameters which can induce postoperative infection are analyzed. The only significative data are the duration of total parenteral nutrition and of intensive care stay. The commonest isolated organisms are gram negative bacilli (61%) and streptococci (30%). Yeasts infections are frequent, and significantly correlated with antibiotic treatment duration.

Topics: Aged; Amikacin; Bacterial Infections; Cefoxitin; Esophageal Diseases; Female; Gram-Negative Bacteria; Humans; Lung Diseases; Male; Middle Aged; Parenteral Nutrition; Postoperative Complications; Premedication; Prospective Studies; Urinary Tract Infections

Cefoxitin is a bactericidal beta lactam antibiotic of the cephamycins group, with wide antimicrobial efficacy and active against both aerobes and anaerobes. In this study, 58 patients were divided in four groups according to the site of the disease (stomach, gallbladder and biliary tract, jejunum ileum and colon-rectum). The efficacy of cefoxitin in the prophylaxis of surgical infections was assessed for each group and for all patients. When compared with the combination of antibiotics used previously, cefoxitin led to a reduction of the mean duration of fever (7.2 and 5 days respectively with ampicillin/cloxacillin and lincomycin/gentamycin, 3.2 days with cefoxitin). Cefoxitin also led to a reduction in the incidence of surgical infections (50% with ampicillin/cloxacillin, 9.19% with lincomycin/gentamycin, 8.6% with cefoxitin) and in the incidence of localized surgical infections (29.6%, 20.3%, 8.6% respectively). In this study, cefoxitin has been found to be very useful and well tolerated in the prophylaxis of surgical infections.

Topics: Adult; Aged; Aged, 80 and over; Bacterial Infections; Cefoxitin; Digestive System Diseases; Drug Administration Schedule; Female; Humans; Male; Middle Aged; Postoperative Complications; Premedication; Risk Factors

In the treatment of infections arisen in neoplastic patients without neutropenia, 2 antibiotic combinations (aztreonam + oxacillin vs tobramycin + cefoxitin), have been compared with regard to therapeutic effectiveness and tolerability. Twenty patients (age: 30-75) have been studied. Tolerability of both combinations was excellent. Results of this study showed a lower percentage of superinfections and a higher percentage of cure in patients treated with the combination aztreonam + oxacillin, even if the data were not statistically significant.

Topics: Adult; Aged; Aztreonam; Bacterial Infections; Cefoxitin; Drug Evaluation; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Neoplasms; Oxacillin; Tobramycin

Nosocomial bloodstream infections add to the morbidity, mortality and length of hospitalization that is attributed to the underlying diseases alone. We have compared the in vitro potency of fifteen antibiotics against 136 isolates from clinically significant nosocomial gram-negative bacteraemias. Ciprofloxacin was the most potent antibiotic and had the broadest spectrum of activity (98% of isolates susceptible, MIC90 range: 0.06-0.5 micrograms ml-1). We subjected all isolates to beta-lactamase induction but antibiotic susceptibility was unaffected by this procedure.

Topics: Anti-Bacterial Agents; Bacterial Infections; beta-Lactamases; Cefoxitin; Ciprofloxacin; Cross Infection; Drug Resistance, Microbial; Gram-Negative Bacteria; Microbial Sensitivity Tests

The clinical efficacy, adverse effects, cost of therapy, and administration time required to treat 141 patients were compared for cefotetan versus cefoxitin (Study A) and cefotetan versus combination antibiotic therapy (Study B). No major differences were observed in clinical efficacy or adverse effects in any of the treatment groups. Cefotetan was more cost-effective than cefoxitin, even though cefoxitin was given for shorter periods. Cefotetan was also more cost-effective than a combination of ampicillin, an aminoglycoside, and clindamycin. Although the ampicillin, aminoglycoside, and metronidazole combination appeared to be the most cost-effective regimen, this combination required the longest administration time (240 percent longer than cefotetan). Cefotetan appears to be comparably efficacious and more cost-effective than other currently used antianaerobic regimens in our institution.

Topics: Aminoglycosides; Ampicillin; Anti-Bacterial Agents; Bacterial Infections; Cefotetan; Cefoxitin; Cephamycins; Cost-Benefit Analysis; Costs and Cost Analysis; Drug Therapy, Combination; Humans; Metronidazole; Retrospective Studies

Infective complications are often seen in colorectal surgery. These even occur in cases of elective surgery and in patients where adequate bowel preparation has been performed and is due to the very high numbers of bacteria colonising the bowel. Several controlled clinical studies showed that antimicrobial prophylaxis is effective in preventing infective complications and the lack of prophylaxis is no longer justified. Antimicrobial prophylaxis can be oral (poorly absorbed antibiotics aimed to reduce the number of bacteria in the bowel) or systemic (aimed to reach a high tissue concentration when bacterial contamination occurs, in order to prevent colonisation) or a combination of the two. Which is to be preferred is still controversial. Systemic prophylaxis should have the following features: 1) use of a single agent with a broad spectrum of action, effective both on aerobes and anaerobes; 2) rapid I.V. administration, at the beginning of surgery; 3) good tissue penetration; 4) long half-life, in order to assure that the single dose will cover the whole duration of surgery; 5) good therapeutic ratio. The use of long half-life cephalosporins, particularly cefotetan, was shown to be highly beneficial. Prophylaxis can fail if contamination during surgery is severe, with a particularly high bacterial count. The degree of contamination of the operating field can be evaluated both by surgeon's judgment, and by tissue or peritoneal cavity lavage fluid sampling and culture. In case of severe contamination (bacterial number greater than 10(5) CFU/ml of fluid or mg of tissue) prolonging of antibiotic therapy for some days is justified. Otherwise, no evidence supports its prolongation beyond surgery.

Topics: Anti-Bacterial Agents; Bacterial Infections; Cefotetan; Cefoxitin; Colon; Female; Humans; Intraoperative Period; Male; Postoperative Complications; Premedication; Random Allocation; Rectum; Surgical Wound Infection

The authors carried out a study to assess the efficacy of an antibiotic treatment (cefotetan or cefoxitin) in 22 stratified patients with biliary sepsis, at low and high risk. The severity of sepsis was assessed by a biliary sepsis score (B.S.S.). No significant difference in results was observed between the two treatments in low-risk groups (cefotetan 80%, cefoxitin 75% satisfactory), while the difference between the high risk groups was significant (cefotetan 75%, cefoxitin 40% satisfactory). In the low risk group it can be stated that better nutritional and immunological status provide adequate host defences and that the antibiotic treatment is less important in determining surgical outcome. In high risk patients the efficacy of an antibiotic, cefotetan in this case, can significantly improve clinical results.

Topics: Aged; Bacterial Infections; Biliary Tract Diseases; Cefotetan; Cefoxitin; Drug Evaluation; Female; Humans; Male; Risk Factors; Severity of Illness Index

Topics: Adult; Aged; Aged, 80 and over; Bacterial Infections; Cefoxitin; Ceftriaxone; Female; Humans; Male; Middle Aged; Postoperative Complications; Premedication; Risk Factors; Stomach Diseases

We present preliminary data on the role of antibiotics in intraabdominal sepsis using a new, clinically relevant animal model. Peritoneal cavity infection was induced by ligation and perforation of the cecum in adult rats. Surviving rats were randomized to receive either saline or cefoxitin at the time of cecal excision and peritoneal lavage, 18 h after the onset of infection. This is different from previous models of abdominal sepsis (in which antibiotics are given within 4 h of peritoneal contamination) and mimics the clinical setting in which antibiotics are initiated much later, at the time of operation. Antibiotic-treated rats received 20 mg cefoxitin i.m. every 8 h for 7 days; controls received saline at similar times. Thirty-nine of 67 control rats died (58%) versus 20 of 64 (31%) that received cefoxitin (p less than 0.005). We conclude that even with delayed administration, antibiotics appear to improve the outcome of intraabdominal sepsis. With further characterization of this model we plan to use it as an in vivo assay to compare the efficacy of different antimicrobial agents in intraabdominal sepsis.

Topics: Animals; Bacterial Infections; Cefoxitin; Disease Models, Animal; Male; Peritonitis; Random Allocation; Rats; Rats, Inbred Strains

Topics: Adult; Bacterial Infections; Cefamandole; Cefonicid; Cefoxitin; Cesarean Section; Cost-Benefit Analysis; Female; Humans; Postoperative Complications; Pregnancy

Two newly described quaternary heterocyclylamino beta-lactams, L-642,946 and L-652,813, were shown to exhibit potent activity against a broad spectrum of aerobic and anaerobic bacteria in vitro. The activity of these agents in vitro translated well to chemotherapeutic activity in experimental bacteremias in mice. Substitution of the thiadiazine moiety of L-642,946 with a triazine moiety effected a marked change in the pharmacokinetics of the new derivative, L-652,813. In mice given a 20 mg/kg subcutaneous dose, the peak serum concentration and the half-life of L-652,813 were about three times greater than those of L-642,946 and the area under the serum concentration/time curve was increased by about 5-fold. The pharmacokinetics of L-652,813 in mice and in rhesus monkeys more closely resembled those of ceftriaxone which carries the same triazine moiety on the C-3 side chain.

Topics: Animals; Anti-Bacterial Agents; Bacteria, Aerobic; Bacteria, Anaerobic; Bacterial Infections; Cefoxitin; Ceftriaxone; Cefuroxime; Cephalosporins; Chemical Phenomena; Chemistry; Female; Macaca mulatta; Male; Mice; Microbial Sensitivity Tests

A clinical investigation was made on the concurrent use of amikacin (AMK) and cefoxitin (CFX) against complicated infections with hematological disorders. The results obtained were summarized as follows: Eleven patients were treated with AMK and CFX. Clinical responses were excellent in 2 (18%), good in 4 (36%), fair in 1 (9%), and poor in 4 (36%), with an efficacy rate of 64%. No significant side effects requiring cessation of the treatment were observed.

Topics: Adolescent; Adult; Aged; Amikacin; Bacterial Infections; Cefoxitin; Drug Evaluation; Drug Therapy, Combination; Female; Humans; Leukemia; Male; Middle Aged

Vascular prosthetic graft infection is one of the most catastrophic problems complicating vascular surgery. The purpose of the present study was to determine the efficacy of binding an antibiotic to a vascular prosthesis via a glucosaminoglycan-keratin luminal coating (GKLC). Ten adult mongrel dogs had polytetrafluoroethylene (PTFE) grafts inserted into the right common carotid artery and PTFE grafts with GKLC bonded with cefoxitin inserted into the left common carotid artery. Before the neck incision was closed, an infusion of 1 X 10(8) Staphylococcus aureus was administered intravenously during a 15-minute period to each dog. Grafts were harvested at 10 different time periods (1, 2, 3, 5, 7, 10, 14, 18, 21, and 28 days). At the time of harvesting, cultures were taken of the lumen of each graft. Washout of antibiotic from the graft lumen was determined by measuring zones of inhibition of disks excised from the antibiotic grafts that were placed on S. aureus plates. Results demonstrated that only 1 of the 10 GKLC-cefoxitin grafts was infected compared with 10 of 10 regular PTFE grafts (p less than 0.003). Regression analysis showed antibiotic elution to occur in an exponential fashion (r = 0.9654) with no detectable antibiotic present after 10 days. GKLC with cefoxitin significantly protects the PTFE graft lumen from infection during bacteremia compared with regular PTFE. The role of antibiotic-bound grafts in relation to the use of intravenous antibiotics will need to be determined by further studies.

Topics: Animals; Bacterial Infections; Blood Vessel Prosthesis; Cefoxitin; Dogs; Glycosaminoglycans; Keratins; Polytetrafluoroethylene; Staphylococcal Infections

The third-generation cephalosporins offer considerable appeal for treatment of specific life-threatening infections (nosocomial pneumonia, meningitis, urosepsis) in elderly patients when the disorders are caused by aerobic gram-negative bacilli. Despite the frequent presence of cross-reactive antibodies in the sera of recipients of cephalosporins, clinically evident serious reactions to cephalosporins occur infrequently in patients with known penicillin allergy.

Topics: Bacterial Infections; Cefamandole; Cefazolin; Cefonicid; Cefotetan; Cefoxitin; Cefuroxime; Cephalosporins; Cephamycins; Geriatrics; Humans

Plasma levels of antibiotics often do not correlate well with their tissue levels. To determine optimal antibiotic coverage for prophylactic effect in vascular surgery, we studied the tissue pharmacokinetics of four cephalosporins in dogs: cefazolin, cefoxitin, cefamandole, and moxalactam for 3 hours after a single (25 mg/kg) intravenous injection. The minimal inhibitory concentration (MIC) of these antibiotics for the three most common pathogens involved in graft infections (Staphylococcus aureus, S. albus, and Escherichia coli) and their tissue concentration (TC) in the plasma, muscle, subcutaneous tissue, and aortic wall were assayed. The data are presented as TC/MIC ratio. Cefoxitin and moxalactam failed to achieve an effective therapeutic TC/MIC ratio (greater than 10) for S. aureus and S. albus in all the tissues studied whereas cefoxitin and cefamandole were above therapeutic levels. All antibiotics achieved an effective therapeutic ratio against E. coli, but cefamandole performed better (p less than 0.05) than cefoxitin; the latter reached effective levels at 3 hours. Cefamandole attained the most effective bioactive aortic tissue levels when the three most common pathogens were considered together and should therefore be considered as an antibiotic agent of choice for prophylaxis in vascular surgery.

Topics: Animals; Aorta; Bacterial Infections; Cefamandole; Cefazolin; Cefoxitin; Cephalosporins; Dogs; Escherichia coli Infections; Kinetics; Moxalactam; Muscles; Staphylococcal Infections; Time Factors; Tissue Distribution; Vascular Surgical Procedures

Activities of cefoxitin and the effect on killing of bacteria in bile from six patients undergoing percutaneous transhepatic biliary drainage were analyzed in relation to in vitro activities of the drug, with particular reference to the incubation time. The bacteriostatic and bactericidal activities of cefoxitin with short term (6 hr) incubation correlated well with the duration of the effective cefoxitin concentration and the decrease of viable bacteria in bile juice from the patients. These timed in vitro activities can be used as well as the conventional MIC and MBC with the prolonged incubation of 24 hr, in the deductive analysis of bacterial response in vivo.

Topics: Aged; Bacterial Infections; Bacteroides fragilis; Bile; Biliary Tract Diseases; Cefoxitin; Drainage; Enterobacter; Escherichia coli; Female; Humans; Kinetics; Klebsiella pneumoniae; Male; Middle Aged

Topics: Anti-Bacterial Agents; Azlocillin; Bacteria, Anaerobic; Bacterial Infections; Cefoxitin; Clindamycin; Humans; Lincomycin; Mezlocillin; Penicillin G

Several antimicrobial agents were evaluated for activity against experimental Legionella micdadei pneumonia in guinea pigs. Erythromycin, rifampin, doxycycline, and sulfamethoxazole-trimethoprim produced significant reductions in mortality. Penicillin, cefazolin, cefoxitin, chloramphenicol, and gentamicin were not efficacious even though, at the doses administered, the peak concentrations of these agents in serum substantially exceeded their MICs for the test strain. It is suggested that the poor performance of the latter group of agents resulted from poor penetration into cells in which L. micdadei was multiplying.

Topics: Animals; Anti-Bacterial Agents; Bacterial Infections; Cefazolin; Cefoxitin; Chloramphenicol; Doxycycline; Drug Combinations; Erythromycin; Gentamicins; Guinea Pigs; Kinetics; Legionella; Male; Penicillin G; Pneumonia; Rifampin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Cefoxitin (CFX) was administrated to a total of 12 hospitalized patients with digestive diseases, in combination with aminoglycosides. The following results were obtained: Clinical effects of CFX on 12 cases were "excellent" in 4 cases, "good" in 5, "fair" in 1 and "unknown" in 2, with the efficacy rate of 75%. All 4 cases who developed septicemia with underlying severe diseases showed "excellent" effect to CFX. Clinical results of 8 cases with hepatic biliary tract infections were "good" in 5, "fair" in 1 and "unknown" in 2, with the efficacy rate in 62.5%. As for side effects, an allergic reaction was observed in 1 case, and it is suggested renal function should be monitored carefully in a case of combination use with aminoglycosides.

Topics: Aged; Bacterial Infections; Biliary Tract Diseases; Cefoxitin; Cholecystitis; Dibekacin; Digestive System Diseases; Drug Therapy, Combination; Female; Gallstones; Gentamicins; Humans; Liver Abscess; Male; Middle Aged; Sepsis

The clinical effects of cefoxitin (CFX) were evaluated in the prophylaxis of postoperative infections in the field of orthopaedics. The clinical response was good in 46 out of 50 patients; an efficacy rate of 92%. Four patients (8%) who did not respond to CFX were suffering from infections due to Mycobacterium tuberculosis (1), suspected Pseudomonas aeruginosa (1), and infection of unknown organism (2). A review was also made of recent trends among clinically isolated bacterial strains and their susceptibility to antibiotics in the field of orthopaedics. CFX is recommended as an antibiotic of first choice for the prophylaxis of postoperative infections in the field of orthopaedics.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefoxitin; Child; Female; Humans; Male; Middle Aged; Orthopedics; Surgical Wound Infection

The concentration of cefoxitin (CFX, Merxin) in dead space exudate was studied in 14 patients following total extirpation of diffuse uterine cervical cancer. A two-compartment model was used for the analysis. The results obtained were as follows: Calculated maximum concentrations of CFX in the pelvic dead space exudate were 26.55 micrograms/ml at 2.11 hours, 31.07 micrograms/mg at 2.01 hours and 51.51 micrograms/ml at 2.10 hours after 1 hour intravenous drip infusions of CFX 2, 3 and 4 g, respectively. These concentrations were higher than the MIC80 of 12.5 micrograms/ml against E. coli and B. fragilis and were maintained for a sufficient period of time. Based on the results of this study, CFX is considered to be an important and valuable drug in the field of obstetrics and gynecology.

Topics: Adult; Aged; Bacterial Infections; Cefoxitin; Female; Humans; Infusions, Parenteral; Middle Aged; Pelvis; Surgical Wound Infection; Uterine Cervical Neoplasms

The authors, after stating the results of their clinical experience on 50 patients subjected to antibiotic prophylaxis with cefoxitin on the occasion of surgical operations on abdomen, compare the results of the antibiotic prophylaxis after a short time with those of the prophylaxis-therapy after an average time.

Topics: Abdomen; Adolescent; Adult; Aged; Bacterial Infections; Cefoxitin; Female; Humans; Male; Middle Aged; Postoperative Complications; Premedication; Time Factors

Clinical studies were done on cefoxitin (CFX), the first cephamycin antibiotic, in the field of obstetrics and gynecology and following results were obtained. CFX was administrated by intravenous drip infusion for average 6.9 days at a daily dose of 2--6 g to 58 patients; 15 with intrauterine infections, 5 with intrapelvic infections, 11 with adnexitis, 3 with mastitis, 5 with urinary tract infections, 2 with other infections and 17 for prophylaxis of postoperative infections. The clinical results were excellent in 8 cases, good in 39 cases, fair in 4 cases, poor in 6 cases and unknown in 1 case, with the efficacy of 82.5%. Total bacteriological effective rate was 88.9%. As to side effects, eruption was observed only in 1 case. From the results of the present study, the usefulness of CFX was demonstrated in the field of obstetrics and gynecology.

Topics: Adult; Aged; Bacteria; Bacterial Infections; Cefoxitin; Drug Evaluation; Female; Genital Diseases, Female; Humans; Infusions, Parenteral; Middle Aged; Pregnancy; Puerperal Infection

The secretion of cephalothin and cefoxitin in stimulated pure pancreatic juice was studied in 13 persons after intravenous administration of antibiotics. Of all these studied, three had acute relapsing pancreatitis, five chronic pancreatitis, and five were control subjects. Antibiotic levels were measured in paired pure pancreatic juice and serum samples at fixed time intervals after administration. Cephalothin was detected in very low levels (1 to 1.8 micrograms/ml) in the pure pancreatic juice of four of the six persons studied (3 micrograms/ml). Although therapeutic levels were not obtained in stimulated pure pancreatic juice with either antibiotic, additional studies evaluating antibiotic levels in unstimulated pure pancreatic juice and in pancreatic tissue would be helpful in assessing the role of antibiotic therapy in the treatment of pancreatitis.

Topics: Acute Disease; Bacterial Infections; Cefoxitin; Cephalothin; Cholangiopancreatography, Endoscopic Retrograde; Chronic Disease; Humans; Pancreatic Juice; Pancreatitis; Premedication; Secretin

This clinical trial was designed to evaluate the efficacy, safety and patient tolerance of cefoxitin (CFS) in 46 patients who were admitted to the hospitals from June 1983 to April 1984. The daily doses of CFX for 34 patients (ages ranged from 6 to 75 years old) were 2 to 8 g to prevent the infections and for 12 patients (ages ranged from 55 to 81 years old) were 2 to 6 g to treat the infections by intravenous drip infusion 1 or 3 times a day in divided doses. The following results were obtained. All of 34 patients with intracranial operation who received CFX for prevention of postoperative infections showed good results. Of 12 patients with postoperative pneumonia, infections of urinary tract and late meningitis, 11 patients showed good results. One patient was discontinued on the 3 days because of the drug eruption which improved 3 days after. The side effect was noted in only 1 patient. This was eruption which improved 3 days after the stop of the administration. The influences to the laboratory data due to CFX were not recognized. The results of this study demonstrated that CFX was an excellent drug for the prevention and treatment of the postoperative infections in the neurosurgical field because of high efficacy rate and safety.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Brain Diseases; Cefoxitin; Child; Female; Humans; Infusions, Parenteral; Male; Middle Aged; Pneumonia; Postoperative Complications; Premedication; Urinary Tract Infections

All patients receiving cefoxitin and cefamandole were prospectively reviewed for appropriate and inappropriate utilization. There were two eight-week survey periods. In period 1, 81 (70%) of 115 patients received cefoxitin appropriately and six (40%) of 15 patients received cefamandole appropriately. In patients receiving antibiotics inappropriately, 12 (35%) of the 34 receiving cefoxitin and eight (89%) of the nine receiving cefamandole had infections that could have been treated with less expensive, equally efficacious antibiotics. Changes in antibiotic therapy were made in 79% of patients based on our recommendations. The estimated annual cost saving for these antibiotics was $40,290. During period 2, 73 (91%) of 80 patients were given cefoxitin appropriately and 14 (61%) of 23 patients received cefamandole appropriately. Forty-three percent of those receiving cefoxitin and 33% of those receiving cefamandole inappropriately could have been treated with a less expensive, equally efficacious antibiotic. In 88% of patients, the attending physicians followed our recommendations.

Topics: Bacterial Infections; Cefamandole; Cefoxitin; Cost Control; Drug Utilization; Hospitals, Community; Hospitals, Teaching; Humans; New Jersey; Prospective Studies

We examined 134 pediatric clinical isolates of Enterobacteriaceae, Pseudomonas aeruginosa, and gram-positive cocci for susceptibility to aztreonam alone and in combination with seven other antibiotics. All 98 gram-negative isolates were susceptible to aztreonam with similar inhibitory and bactericidal activity. Combinations of aztreonam with cefoxitin, ampicillin, or clindamycin were generally indifferent or additive. Synergism was occasionally seen against enteric organisms with aztreonam plus cefoxitin or clindamycin. Combinations of tobramycin and aztreonam were synergistic (62%) against P. aeruginosa; aztreonam plus piperacillin or ticarcillin was additive. Aztreonam did not affect the activity of nafcillin against Staphylococcus aureus, or of ampicillin against species of Streptococcus group B or D. Antagonism was seen only with aztreonam plus cefoxitin against Enterobacter species, but not at clinically significant concentrations. Several combinations of antibiotics with aztreonam should be appropriate for initial therapy of infections in children without major risks of antibacterial antagonism.

Topics: Anti-Bacterial Agents; Aztreonam; Bacteria; Bacterial Infections; Cefoxitin; Child; Drug Synergism; Humans; Microbial Sensitivity Tests; Time Factors; Tobramycin

Early diagnosis and early operation of underlying disease are the basis of preventing and treating peritonitis. At operation, besides meticulous technique, minimal contamination and short-term antibiotic prophylaxis diminish the incidence of established infection. Once peritonitis is manifest, massive antibiotic therapy must supplement surgical measures. Open treatment of the septic abdomen can be recommended as a simple and safe procedure with acceptable complications; continuous dorso-ventral lavage in addition may prove beneficial in certain patients.

Topics: Aged; Aminoglycosides; Bacterial Infections; Cefoxitin; Drainage; Humans; Intraoperative Care; Isotonic Solutions; Metronidazole; Mezlocillin; Peritonitis; Postoperative Care; Ringer's Solution; Surgical Wound Infection; Therapeutic Irrigation

A prospective randomized blinded study was conducted comparing a single 2-g preoperative dose of cefoxitin with three 2-g doses of cefoxitin over 12 hours given to premenopausal women scheduled for vaginal hysterectomy in Parkland Memorial Hospital. The incidence of major pelvic infection in 58 women given one dose was 1.7%, and it was 3.7% for 54 women given three doses. The mean hospital stay (4.5 days) was similar for both regimens; for those who developed major infection it was eight days. More aerobic bacteria with altered species dominance and fewer anaerobic bacteria were recovered from the vaginal cuff at discharge from the hospital when compared with those recovered from the endocervix preoperatively. There was a trend toward increasing minimal inhibitory concentrations to cefoxitin in bacteria isolated after surgery, which was more frequent in women given three doses. There was not a statistically significant intergroup difference in the recovery of bacteria resistant to cefoxitin in vitro after surgery. A single preoperative dose of cefoxitin was as effective in preventing major infection as were three perioperative doses, while providing other real and theoretic benefits.

Topics: Adult; Bacterial Infections; Cefoxitin; Drug Administration Schedule; Female; Humans; Hysterectomy; Hysterectomy, Vaginal; Menopause; Premedication; Prospective Studies; Random Allocation

Cefoxitin (CFX) was administered to 49 hospitalized patients in the surgical field, and the following results were obtained: Clinical results of the 12 patients with surgical infections were excellent in 1 patient, good in 10, and poor in 1, with the efficacy rate of 91.7%. CFX was also administered to 37 patients for prophylaxis of postoperative infections, and the clinical efficacy rate was 91.7%. No side effects were seen besides mild eruption in 1 patient. The above results indicate that CFX is exceeding useful in surgical field.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefoxitin; Drug Evaluation; Female; Humans; Male; Middle Aged; Premedication; Surgical Wound Infection

The in vitro activity of cefoxitin was compared with those of metronidazole and clindamycin against 322 strains of anaerobic bacteria collected from several hospitals during 1982 and tested by an agar dilution method. Metronidazole and cefoxitin inhibited at least 89% of strains tested, whereas clindamycin was less active.

Topics: Bacteria, Anaerobic; Bacterial Infections; Cefoxitin; Clindamycin; France; Humans; Metronidazole; Microbial Sensitivity Tests

In order to evaluate the efficacy of cefoxitin, 25 patients with serious pelvic infections admitted to a community hospital were treated with the drug. Twenty-one patients (84%) responded to this therapy. Three of the four failures (75%) had a pelvic abscess. Resistant organisms included Staphylococcus aureus, Pseudomonas aeruginosa and enterococci. The adverse reactions encountered were due to localized phlebitis, which occurred in three patients (12%). The study demonstrated that cefoxitin was successful as a single agent in the treatment of serious soft-tissue pelvic infections.

Topics: Adult; Bacterial Infections; Cefoxitin; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infusions, Intravenous; Length of Stay; Microbial Sensitivity Tests; Middle Aged; Pelvic Inflammatory Disease; Thrombophlebitis; Treatment Failure

One hundred fifty-five patients with 157 febrile episodes were treated with amdinocillin or amdinocillin and cefoxitin as second-line therapy, or amdinocillin and ticarcillin or carbenicillin as initial therapy in three separate studies. Overall responses were 57 percent, 55 percent, and 54 percent for amdinocillin, amdinocillin-cefoxitin, and amdinocillin-ticarcillin or amdinocillin-carbenicillin, respectively. In all three studies, patients with septicemia responded less often than patients with other infections. Most patients were profoundly neutropenic at the initiation of therapy, and both the initial neutrophil level and neutrophil trend during therapy influenced response. A significant number of superinfections occurred when amdinocillin alone was used. Although amdinocillin, alone or in combination with cefoxitin, appeared effective as second-line therapy in infections with organisms shown sensitive in vitro, the combination of amdinocillin and ticarcillin or carbenicillin was only moderately effective in initial therapy for neutropenic, febrile, cancer patients.

Topics: Acute Disease; Adolescent; Adult; Aged; Amdinocillin; Bacterial Infections; Carbenicillin; Cefoxitin; Drug Therapy, Combination; Female; Humans; Leukemia; Leukocyte Count; Male; Middle Aged; Neutrophils; Penicillanic Acid; Penicillins; Sepsis; Ticarcillin

Cefoxitin (CFX) was administered to 13 patients who were admitted to the surgical ward of the hospital. The results of the study as follows; Disc susceptibility tests of the 11 strains isolated from the patients to antibiotic were performed and 10 strains showed good susceptibility to CFX. The clinical response was good in all 4 patients with surgical infections. It is noted that 1 patient with mixed infection caused by E. coli, Clostridium sp. and Bacteroides sp. showed good response to CFX. Out of 9 patients treated with CFX for prophylaxis of postoperative infections, 8 patients responded effectively to CFX, and clinical efficacy rate was 88.9%. No side effects were noted due to CFX. It is considered from these results of the study that CFX is a highly effective and safe drug for treatment of infections and for the prevention of postoperative infections in surgery.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Bacteroides; Cefoxitin; Drug Evaluation; Drug Resistance, Microbial; Escherichia coli; Female; Humans; Klebsiella pneumoniae; Male; Middle Aged; Premedication; Surgical Wound Infection

Topics: Anti-Bacterial Agents; Bacteria, Anaerobic; Bacterial Infections; Bacteriological Techniques; Cefoxitin; Clindamycin; Drug Resistance, Microbial; Humans; Metronidazole

beta-Lactamases have proved to be extremely important in influencing therapy with penicillins and cephalosporins against gram-positive and gram-negative aerobic and anaerobic species. Both plasmid mediated beta-lactamases which are primarily of a constitutive penicillinase type and the inducible chromosomal enzymes which are primarily cephalosporinases are important. The use of penicillins to treat Haemophilus, Neisseria gonorrhoeae, Escherichia coli, Klebsiella, Salmonella, Shigella and Pseudomonas infections must be based upon the relative incidence of beta-lactamase producing strains. In the same manner cephalosporins can be used to treat infections due to Enterobacter, Serratia and Bacteroides only if the compounds are beta-lactamase stable and not good inducers of beta-lactamase activity. Although altered permeability is important in the resistance of some Pseudomonas and Enterobacter to beta-lactams, the resistance really is due to a combination of reduced entry of molecules and strategically placed beta-lactamases. It is only in some Streptococcus pneumoniae, methicillin-resistant Staphylococcus aureus and Streptococcus faecalis strains that altered penicillin-binding proteins make a significant contribution to the resistance to beta-lactams. beta-lactamases will continue to be the most important factor in clinically significant resistance of bacteria to both penicillins and cephalosporins.

Topics: Bacillus cereus; Bacterial Infections; beta-Lactamases; Cefoxitin; Cell Membrane Permeability; Cephalosporins; Enzyme Induction; Gram-Negative Bacteria; Gram-Positive Bacteria; Haemophilus Infections; Humans; Penicillins; Plasmids

Topics: Bacterial Infections; beta-Lactamases; Cefoxitin; Cephalosporins; Drug Resistance, Microbial; Humans

Topics: Amoxicillin; Bacterial Infections; Cefoxitin; Erythromycin; Female; Humans; Intervertebral Disc; Middle Aged; Ornidazole; Peptococcus; Propionibacterium acnes; Spinal Diseases

The authors report 57 febrile episodes in 36 patients with leukemia and lymphoma. Patients with less than 1000 granulocytes and fever above 38.5 degrees C were included in this empirical antibacterial protocol (15 mg amikacin/kg/day/iv, 500 mg carbenicillin/kg/day/iv, 200 mg cefoxitin/kg/day/iv). The criteria for diagnosis of infection were those widely accepted [Schimpff et al. 1971]. Microbiologic documentation of infection was performed in 33.4% of febrile episodes. Antibacterial therapy induced an improvement in 75.1% of cases. Clinical response often occurred in the presence of profound granulocytopenia (in 72% of episodes). Therapy failure was higher in pneumonia (46%) and lower in fever of unknown origin (21%).

Topics: Adult; Aged; Agranulocytosis; Amikacin; Bacterial Infections; Carbenicillin; Cefoxitin; Drug Therapy, Combination; Female; Fever; Humans; Kanamycin; Leukemia; Lymphoma; Male; Middle Aged

The Gainesville staging of acute salpingitis subdivides the complexity of clinical disease into four major stages. Each stage is predicated upon distinct therapeutic goals and different therapeutic regimens for achieving the principal goal of each stage.. The classical signs of salpingitis are fever, bilateral adnexal tenderness and/or the presence of masses, and signs of an elevated white blood count (WBC) and erythrocite sedimentation rate. These are absent in the majority of women. Acute salpingitis should be suspected in any woman with lower abdominal discomfort and can be verified by needle culdocentesis. Proper staging can be a deciding factor in the patient's cure and future fertility and helps in the selection of antibiotics. The presence or absence of Neisseria gonorrhoeae should be determined first. Some complicating factors during these procedures include: 1) the presence of an IUD when disease within the fallopian tubes tends to be more advanced than can be ascertained from clinical findings, 2) prior inflammatory disease of the fallopian tube, and 3) bilateral tubal ligation. If peritonitis has been inferred by the demonstration of rebound tenderness or by culdocentesis, confirmation can be achieved by ultrasonography or CAT scan of the pelvis. Once the variables have been identified the information can be assessed according to the current classification of acute salpingitis; staging is an attempt to create clinical subjects based upon the fact that each differs in its major therapeutic goal. For acute salpingitis without peritonitis, therapy is with doxycycline. For acute salpingitis with peritonitis, in order to preserve fallopian structure and function, there has to be adequate coverage for principal venereal pathogens, and treatment is a combination of cefoxitin and doxycycline. For acute salpingitis with evidence of tubal occlusion or ruptured tuboovarian complex treatment is with penicillin, clindamycin, and tobramycin. For a case of ruptured tuboovarian complex combinations of antibiotics are used and if these fail surgery is indicated.

Topics: Acute Disease; Anti-Bacterial Agents; Bacterial Infections; Cefoxitin; Chlamydia Infections; Doxycycline; Female; Humans; Peritonitis; Salpingitis

Fifteen patients less than 2 months old with bacterial infections caused by pathogens known or presumed to be sensitive to cefoxitin were studied. Cefoxitin was administered as an i.v. bolus injection over 15 min, every 8 h for 6 to 12 days, to a total daily dosage of 90 mg/kg. In 14 patients cefoxitin therapy resulted in eradication of the pathogen and in recovery from clinical signs of infection. Only one patient did not respond to cefoxitin therapy. No adverse clinical or haematological effects definitely caused by cefoxitin were observed. Plasma and urine samples collected after the first dose were assayed for cefoxitin by HPLC. Pharmacokinetic data indicated larger apparent volume of distribution (0.5 1/kg), a smaller plasma clearance (0.27 1/h/kg) and a longer half-life (1.43 h) than in adults. The plasma half-life was inversely correlated (p less than 0.05) to the postnatal age of the patients. Cefoxitin may be safely used in infants with infections caused by susceptible pathogens.

Topics: Bacterial Infections; Cefoxitin; Chromatography, High Pressure Liquid; Drug Evaluation; Female; Half-Life; Humans; Infant; Infant, Newborn; Kinetics; Male

Ten inpatients at the Second Department of Internal Medicine, Mie University Hospital, developed infections in the course of treatment for hematopoietic disorders and were administered cefoxitin (CFX). Patients suffered from the following infections: pharyngitis, 2; bronchitis, 2; pneumonia, 2; sepsis, 2; bacteremia, 1; suspected cases of bacteremia, 2; and fever of unknown origin, 1. The number of infections totaled 12 as 1 patient with pharyngitis also developed sepsis and 1 patient with pneumonia developed bacteremia. Duration for the administration of CFX ranged between 5 and 18 days with a total dosage of between 30 and 108 g. Of the 10 patients treated with CFX, 9 were treated concomitantly with micronomicin (MCR), doxycycline (DOXY), or sulbenicillin (SBPC), some were treated concomitantly with only 1 of the drugs and some were treated concomitantly with 2 of the drugs. The following clinical results were obtained: Following treatment, 4 patients were considered "excellent", 5, "good", and 3, "poor". Clinical efficacy rate was 75%. Four strains of Gram-positive cocci (1 strain of S. aureus, 2 strains of S. epidermidis and 1 strain of Streptococcus sp.) and 3 strains of Gram-negative rods (2 strains of P. aeruginosa and 1 strain of E. cloacae) were found in the clinical specimens of the 10 patients. These results differed somewhat from reported data that Gram-negative rods such as E. coli, Klebsiella sp., Pseudomonas sp., Serratia sp., are dominant. No serious side effects requiring cessation of treatment were observed. Elevations in the levels of S-GOT, S-GPT, serum alkaline phosphatase, blood urea nitrogen, etc. were observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefoxitin; Drug Evaluation; Female; Humans; Leukemia; Lymphoma; Male; Middle Aged; Multiple Myeloma

A total of 39 patients was admitted to the obstetric and gynecological wards of Nagoya University Hospital and the University's 5 related hospitals during the period from July 1981 to March 1982. The efficacy of cefoxitin sodium was evaluated in the 39 patients with a wide variety of obstetric and gynecological infections. The findings are the follows: Of the 39 patients, the responses in 7 were judged "excellent", 28 "good" and 4 "poor" with the clinical efficacy rate of 89.7%. The causative pathogens in 23 of the cases were isolated from clinical materials submitted to the Institute of Anaerobic Bacteriology, School of Medicine, Gifu University. In these 23 cases, it was found that 8 were due to aerobic bacteria only (34.8%), 8 mixed aerobic-anaerobic bacteria (34.8%) and the remaining 6 anaerobic bacteria only (26.1%), i.e. a substantial percentage (60.9%) was due to anaerobic bacteria or mixed aerobic-anaerobic bacteria. Cefoxitin was active against most strains of Bacteroides spp. and was not affected by the inoculum size. On the other hand, most strains of Bacteroides spp. were resistant to cefazolin when the inoculum size was increased from 10(6)/ml to 10(8)/ml. Lincomycin was also found to be active against many fo the strains of Bacteroides spp. Cefoxitin and cefazolin were fairly active against anaerobic bacteria other than Bacteroides spp., while these same bacteria were resistant to sulbenicillin and many of them showed resistance to lincomycin. Cefoxitin was well tolerated and no untoward side effects were observed. The clinical and bacteriological results indicate that cefoxitin is a very effective antibiotic in the treatment of a wide variety of obstetric and gynecological infections and is a suitable choice as initial antibiotic therapy in these conditions.

Topics: Adolescent; Adult; Aged; Bacteria; Bacterial Infections; Cefoxitin; Drug Evaluation; Drug Resistance, Microbial; Female; Genital Diseases, Female; Humans; Middle Aged; Pregnancy

Topics: Animals; Bacterial Infections; Cefoxitin; Chloramphenicol; Gentamicins; Metronidazole; Mice; Mice, Inbred ICR; Peritonitis

A case of Flavobacterium meningosepticum ventriculitis is described in which the failure of therapy with a combination of rifampicin and erythromycin is attributed to inadequate antibiotic levels in cerebrospinal fluid. The successful eradication of the organism was achieved with the use of mezlocillin and cefoxitin given by the intravenous and intraventricular route. In vitro sensitivity tests of recently isolated strains of Flavobacterium meningosepticum suggested that the combination mezlocillin and cefoxitin is more often synergistic than rifampicin and erythromycin.

Topics: Anti-Bacterial Agents; Bacterial Infections; Cefoxitin; Cerebral Ventricles; Drug Therapy, Combination; Encephalitis; Erythromycin; Female; Flavobacterium; Humans; Infant; Mezlocillin; Microbial Sensitivity Tests; Penicillins; Rifampin

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: Bacterial Infections; Cefoxitin; Humans; Infant, Newborn; Infant, Newborn, Diseases

Topics: Anti-Bacterial Agents; Bacteria; Bacterial Infections; Cefotetan; Cefoxitin; Cephalosporins; Cephamycins; Humans; Microbial Sensitivity Tests

Cefoxitin, a new beta-lactamase-resistant cephamycin, was evaluated in 66 patients for clinical and bacteriological efficacy, serum levels, tolerance, and toxicity. Seventeen patients had soft tissue infections, 14 had pleuropulmonary infections, 14 had intraabdominal infections, 13 had pelvic infections, and 8 had urinary tract infections. Among the 66 patients, 62 were cured and 4 could not be evaluated. Twelve patients had hospital-acquired infections, 31 had underlying disease, and 45 required a surgical procedure. Isolates included 116 aerobic and 72 anaerobic bacteria. Cefoxitin was more active than cephalothin against facultative and obligate anaerobic gram-negative organisms isolated from these patients. Mean peak cefoxitin levels in sera were 52 micrograms/ml after a 2-g infusion and 30 micrograms/ml after a 1-g infusion. Phlebitis occurred in two patients, eosinophilia in one, rash in two, vasculitis in one, and transient rises in SGOT and SGPT in two. Cefoxitin appears to be a safe and effective drug for the treatment of many aerobic, anaerobic, and mixed aerobic-anaerobic infections.

Topics: Adult; Aerobiosis; Aged; Anaerobiosis; Bacteria; Bacterial Infections; Cefoxitin; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Respiratory Tract Infections; Urinary Tract Infections

A clinical trial with a special emphasis on anaerobic infections was designed for evaluation of the efficacy, safety, and patient tolerance of cefoxitin. Of the 35 patients who clinically evaluated, 19 had intrareproductive organ infections, 8 had extrareproductive organ infections and 8 had urinary tract infections. Twenty-nine out of the 35 (82.9%) responded satisfactorily to therapy with cefoxitin. The daily dose of cefoxitin for the 35 adult patients (ages ranged from 17 to 62 years) were 1--6 g. There were no adverse systemic reactions, nor was any renal or hematologic toxicity noted. Antibacterial activity tests demonstrated that cefoxitin was active against anaerobic bacteria, especially Bacteroides fragilis. Cefoxitin is thought to be the drug of choice in the treatment of obstetric and gynecologic infections.

Topics: Adolescent; Adult; Bacteria; Bacterial Infections; Cefoxitin; Drug Evaluation; Drug Resistance, Microbial; Female; Genital Diseases, Female; Humans; Middle Aged

49 patients were given cefoxitin in combination with azlocillin, and 15 were given an aminoglycoside as well when severe bacterial infection was suspected. In 39 cases a prompt amelioration of the clinical signs of infection was observed. Of the 17 patients who died, a post-mortem was performed in seven; only in four were signs of bacterial infection present; one had tuberculosis and one had a cytomegalovirus infection. The combination therapy was well tolerated and side-effects were rare; no bleeding complications were seen. Clinical signs of possible antagonism between the two beta-lactam antibiotics were not observed.

Topics: Adult; Amikacin; Aminoglycosides; Anti-Bacterial Agents; Azlocillin; Bacterial Infections; Cefoxitin; Drug Therapy, Combination; Female; Gentamicins; Humans; Male; Middle Aged; Penicillins; Tobramycin

Ten patients (8 with moderate or severe infections, 2 for prevention of postoperative infections) were treated with cefoxitin. The patients were given cefoxitin of 2 approximately 9 g, given once, or in 2 approximately 3 divided doses. Clinical efficacy was good in 7 cases, fair in 2 and poor in 1. Transient nausea and vomiting occurred in 1 patient when a direct intrauterine injection (1 g of cefoxitin) was given, however, no side effects were observed in the other patients. The result of this study demonstrates that cefoxitin when given massively is effective in achieving bacteriologic and clinical cure in treatment of infections and for prevention of postoperative infections in the field of obstetrics and gynecology.

Topics: Adult; Bacterial Infections; Cefoxitin; Cesarean Section; Female; Genital Diseases, Female; Humans; Infusions, Parenteral; Middle Aged; Postoperative Complications; Pregnancy; Premedication; Puerperal Infection

Topics: Adult; Aged; Bacterial Infections; Cefoxitin; Cholangitis; Female; Humans; Male; Middle Aged; Peritonitis; Respiratory Tract Infections; Surgical Wound Infection; Urinary Tract Infections

Eleven paediatric patients ranging in age from 7 weeks to 7 years were treated with intravenous cefoxitin for a variety of moderate or severe infections. All identifiable pathogens were sensitive to cefoxitin and the clinical outcome for every patient was regarded as a cure. Cefoxitin was well tolerated by all patients, the institution of therapy being associated in many cases with a rapid improvement in clinical condition.

Topics: Bacterial Infections; Cefoxitin; Child; Child, Preschool; Drug Tolerance; Female; Humans; Infant; Male; Microbial Sensitivity Tests; Sepsis

Cefoxitin (CFX) was administered to 12 patients for evaluation of clinical effects of CFX against secondary infections complicated with hematopoietic malignancies, and the following results were obtained. 1. The clinical effects were excellent in 1 and good in 8 out or 11 cases with efficacy rate of 81.8%. Out of 12 cases treated with CFX, 1 case was excluded from clinical evaluation because of prophylactic use. It is noted that all cases with pyelitis showed good response to CFX. 2. The serum levels of CFX were determined in 1 patient with renal failure. After intravenous drip infusion of 2 g in 200 ml of glucose solution, the serum concentrations were 67.2 micrograms/ml and 7.53 micrograms/ml at 14 hours and 24 hours (after hemodialysis), respectively. 3. No side effects attributed to CFX were observed. These results indicate that CFX is an effective and safe antibiotic for the treatment of severe infections accompanying hematopoietic malignancies.

Topics: Adult; Bacterial Infections; Cefoxitin; Drug Evaluation; Female; Humans; Leukemia; Lymphoma; Male; Middle Aged; Multiple Myeloma

Topics: Adult; Aged; Bacterial Infections; Cefoxitin; Evaluation Studies as Topic; Female; Genital Diseases, Female; Humans; Middle Aged; Postoperative Complications; Premedication

A total of 16 hospitalized patients underwent surgery for gastroenterological problems in the Department of Gastroenterological Surgery, Kanazawa Medical College Hospital, during the period from April 1981 to September 1981. After they had undergone partial or total gastroenterological resection, cefoxitin was administered for the prevention of postoperative infections. The following findings were obtained. 1. Fifteen out of 16 patients responded well with the clinical efficacy of 94 percent. 2. Elevations in S-GOT levels were noted in 3 patients. However, no other abnormalities were evident in the clinical data. 3. These clinical results indicate that cefoxitin is an effective antibiotic for the prevention of postoperative infections in gastroenterological surgery.

Topics: Adult; Aged; Bacterial Infections; Cefoxitin; Cholelithiasis; Female; Gastrectomy; Humans; Male; Middle Aged; Postoperative Complications; Stomach Neoplasms; Surgical Wound Infection

A total of 24 patients who was hospitalized in the Internal Medicine Wards of Yamaguchi University attached Hospital and the university's 3 related hospitals were administered with cefoxitin. The breakdown of the patients treated with cefoxitin was 7 with cholecystitis, 7 with choledochitis and the remaining 10 for the prevention of infections with obstructive jaundice. Daily doses of 2-6 g of cefoxitin were administered for 6-40 days by intermittent intravenous drip infusion in divided doses.. 1. Of 14 patients with biliary tract infections, 10 (71.4%) responded favorably with cefoxitin. 2. Of 10 patients with obstructive jaundice used for the prevention of infections, 8 (80%) responded favorably with cefoxitin. 3. No untoward side effects were observed. 4. Cefoxitin proved to be a safe and effective antibiotic in the treatment of biliary tract infections and for the prevention of infections in patients with obstructive jaundice.

Topics: Adult; Aged; Bacterial Infections; Biliary Tract Diseases; Cefoxitin; Cholestasis; Drug Evaluation; Female; Humans; Male; Middle Aged; Premedication

A total of 20 hospitalized patients underwent orthopedic surgery in the Tokyo Metropolitan Police Hospital during the period from December 1981 to March 1982. These patients were treated with cefoxitin, mainly, for the prevention of postoperative infections. The following clinical findings were obtained. 1. Out of the 20 patients, 14 were judged 'good' and 6 'fair'. 2. No side effects were reported by the patients or were evident in the clinical data. 3. These clinical results indicated that cefoxitin is a very effective antibiotic for the prevention of postoperative infections in orthopedic surgery.

Topics: Adult; Aged; Bacterial Infections; Cefoxitin; Drug Evaluation; Female; Humans; Male; Middle Aged; Postoperative Complications; Premedication

Topics: Bacterial Infections; Cefoxitin; Female; Humans; Male; Middle Aged; Postoperative Complications

A total of 19 patients who had local or systemic infections with a variety of difficult-to-treat blood disorders were treated with cefoxitin (CFX). The following findings were obtained. 1. Fifteen out of 19 patients' responses were judged "excellent" or "good" with an overall cure rate of 78.9%. 2. As to the side effects of CFX, transient elevations in S-GOT, S-GPT were observed in 3 patients, urine protein in 2 patients, and hematuria in 1 patient. However, these abnormalities cannot be solely attributed to CFX because these patients were treated with either antitumor agents or aminoglycosides, and some had undergone blood transfusions. 3. CFX should be considered for the treatment of severe infections because it is well tolerated, has a broad spectrum of antibacterial activity against both Gram-positive and Gram-negative pathogens and is highly resistant to beta-lactamases.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefoxitin; Child; Drug Evaluation; Female; Hematologic Diseases; Humans; Male; Middle Aged

The in vitro activity of cefmenoxime (SCE-1365 or A-50912), a new semisynthetic cephalosporin antibiotic, was compared with those of cefazolin, cefoxitin, and cefamandole against a broad spectrum of 486 organisms and with that of cefotaxime against 114 organisms. Cefmenoxime and cefotaxime exhibited nearly equivalent activities against those organisms tested and were the most active of these cephalosporins against all aerobic and facultative organisms except Staphylococcus aureus. The minimum inhibitory concentration (MIC) of cefmenoxime required to inhibit at least 90% of strains tested (MIC(90)) ranged from 0.06 to 8 mug/ml for the Enterobacteriaceae. The MIC(90)s for gram-positive cocci were 0.015 and 128 mug/ml with good activity against the gram-positive organisms. In addition, cefmenoxime activity was bactericidal and only slightly affected by differences in inoculum size. The combination of cefmenoxime and gentamicin was synergistic against 80% of the Enterobacteriaceae and 100% of P. aeruginosa strains tested. Development of resistance to cefmenoxime was slow or absent for organisms with low initial MICs but more rapid for those with higher initial MICs. Cefmenoxime exhibited good protective activity in mice infected with Escherichia coli, Enterobacter cloacae, Proteus mirabilis, Proteus vulgaris, or S. aureus but was less effective against P. aeruginosa.

Topics: Animals; Bacteria; Bacterial Infections; Cefamandole; Cefazolin; Cefmenoxime; Cefotaxime; Cefoxitin; Cephalosporins; Drug Synergism; Female; Mice

Topics: Aminoglycosides; Anti-Bacterial Agents; Bacterial Infections; Carbenicillin; Cefoxitin; Cephamycins; Chloramphenicol; Clindamycin; Drug Combinations; Female; Gastrointestinal Diseases; Genital Diseases, Female; Gram-Negative Anaerobic Bacteria; Humans; Male; Moxalactam; Respiratory Tract Infections; Skin Diseases, Infectious; Suppuration; Ticarcillin

The Clostridia remain a frequent cause of anerobic infections and they also remain fully sensitive to benzylpenicillin, which continues to be the antibiotic of choice in their treatment. Penicillin is also the first choice for the treatment of dental and pulmonary infections due to anaerobic bacteria. However, currently the anerobic pathogen most frequently encountered in infections related to the gastro-intestinal and genital tracts is Bacteroides fragilis, an organism which produces beta-lactamase active against both the penicillins and cephalosporins. The antibiotics available for the treatment of B. fragilis infections are the tetracyclines, chloramphenicol, clindamycin, metronidazole and cefoxitin. Since at least 30% of strains of B. fragilis are now resistant to tetracycline and in view of the serious potential toxicity of chloramphenicol, the choice of agent thus lies with the latter three antimicrobial agents. If the in vitro activity of these agents is considered in relation to their pharmacodynamics, it is clear that only clindamycin and metronidazole can be expected to be effective in over 90% of infections with B. fragilis. Studies of the bactericidal activity of these agents against B fragilis have shown a kill of greater than 10(7) in 6 hours in metronidazole, of 10(5) to 10(6) in 30 hours in clindamycin and of 10(2) in 24 hours with cefoxitin.

Topics: Anaerobiosis; Bacterial Infections; Cefoxitin; Clindamycin; Humans; Metronidazole

Topics: Aged; Bacterial Infections; Bacteroides fragilis; Bacteroides Infections; Cefoxitin; Diverticulitis; Female; Humans; Middle Aged

Topics: Aged; Bacterial Infections; Cefoxitin; Female; Humans; Male; Urinary Tract Infections

In basic pharmacological studies, sodium cefoxitin has proved to possess the following features: a broad action spectrum, resistance to bacterial beta-lactamase, activity against anaerobic species, rapid distribution, rapid serum and bile concentration, rapid, elevated excretion in the urine in active form, and low local and general toxicity. Patients in an Emergency Surgery Department often present the following conditions: highly compromised general situation, serious, often polymicrobic sepsis with aerobic and anaerobic flora, prior treatment without result with various cycles of chemo-antibiotic treatment. The theoretical conditions therefore exist to assess the effectiveness of sodium cefoxitin in patients admitted to an emergency surgery department and presenting serious post-surgical or post-traumatic sepsis, or sepsis due to pathology that can be corrected surgically. A study of 14 patients (3 g i.v. or i.m. for 6 days) showed 71% complete cure, 21% definite improvements and one death (treatment commenced 36 hours prior to death). It is therefore maintained that sodium cefoxitin is particularly indicated as first-choice antibiotic in emergency surgery situations.

Topics: Bacterial Infections; Cefoxitin; Emergency Service, Hospital; Humans; Sepsis; Surgical Procedures, Operative; Wounds and Injuries

None of the 46 strains of anaerobic bacteria tested, including 26 strains of Bacteroides fragilis, showed tolerance (minimal bactericidal concentration/minimum inhibitory concentration ratio >32) to cefoxitin.

Topics: Anaerobiosis; Bacteria; Bacterial Infections; Bacteroides fragilis; Cefoxitin; Drug Resistance, Microbial; Humans; Species Specificity

Cefoxitin (CFX) was evaluated for its safety and efficacy in children. Fifteen patients were treated with 73-125 mg/kg per day of CFX by intravenous administrations. The diagnosis of the patients were acute pharyngitis (4), pneumonia (2), pertussis and pneumonia (1), urinary tract infection (3); and the remaining 5 patients were esteemed to have nonbacterial infections. All the 10 patients of bacterial infections were cured after the CFX therapy. The pathogens recovered were Streptococcus pyogenes (1), Streptococcus pneumoniae (3), Haemophilus influenzae (2), Escherichia coli (2), enteropathogenic Escherichia coli (1), and Klebsiella pneumoniae (1). All the strains isolated were susceptible to CFX, but the 2 isolates of Haemophilus influenzae had relatively high MIC values (12.5 mcg/ml). Diarrhea (3 cases) and transient neutropenia (1 case) were found to be associated with the CFX therapy. However, no severe adverse reactions were encountered. Half-life of the serum level was short (24.1 minutes) and excretion into the urine was rapid. CSF concentration obtained 30 minutes after an intravenous injection of 50 mg/kg of CFX in 1 case with inflamed meninges was considerably high (8.3 mcg/ml). CFX appears to be a safe and effective antibiotic when used in children with susceptible bacterial infections.

Topics: Age Factors; Bacterial Infections; Cefoxitin; Child; Child, Preschool; Drug Evaluation; Female; Humans; Infant; Male

Following are the results obtained from studies made with cefoxitin in the field of pediatrics: (1) The peak serum level observed upon completion of the one hour drip infusion in a dose of 20-25 mg/kg of cefoxitin varied from 66.4 to 93.0 mcg/ml. This fell to a remarkably low level after 2 hours. The serum half-life varied from 18.84 to 27.86 minutes. (2) The cumulative quantity of cefoxitin excreted in the active form in the urine by the end of 6 hours after completion of the drip infusion was 92.9-93.8%. (3) All of the 42 patients with acute pediatric infection (such as various kinds of acute upper or lower respiratory tract infection, urinary tract infection were treated with either cefoxitin by a single shot (23 patients), or by drip infusion (19 patients). The dosage employed was approximately 50-100 mg/kg/day divided into two to three treatments. There was no major difference in the clinical efficacy between administering two times or three times, the efficacy rates being 96% and 89% respectively. The overall efficacy rate was 93%. (4) In either case of intravenous injections by either a single shot or drip infusion, excellent clinical responses were obtained in most patients. These people had a variety of infections, which were considered to be caused by various kinds of Gram-positive cocci, E. coli (including ABPC resistance), P. mirabilis, Kl. oxytoca and Haemophilus. (5) Out of the 42 patients who received cefoxitin in a daily dose of 5-100 mg/kg divided into two or three times either by a single shot or drip infusion, no hepatic or renal function abnormality was observed except for 2 cases of temporary eosinophilia. (6) On the basis of these results, cefoxitin was found to be a highly useful antibiotic in the treatment of acute pediatric infection caused by microorganisms which are sensitive to cefoxitin.

Topics: Age Factors; Bacterial Infections; Cefoxitin; Child; Child, Preschool; Drug Evaluation; Female; Humans; Infant; Injections, Intravenous; Male

Laboratory and clinical studies were performed on a newly introduced antibiotic of the cephamycin series, cefoxitin (CFX), and the results obtained were as follows: 1. Employing clinical isolates, MICs were determined and comparisons made with those of cephalosporins. The MICs of CFX against S. aureus and S. pyogenes slightly inferior to those of the cephalosporins, while the MICs of CFX against Gram-negative bacilli such as E. coli, Proteus sp. and Klebsiella sp. were considerably superior to those of CER and CET, and slightly superior to those of CEZ. 2. The peak serum concentrations were 34.7 mcg/ml and 67.6 mcg/ml at 30 minutes after an intravenous injection in doses of 12.5 mg/kg and 25 mg/kg, respectively. The peak serum concentration was 40.8 mcg/ml at the end of 60 minutes intravenous drip infusion when it was given in a dose of 25 mg/kg. In these cases, the serum half life were 25.8-51.2 minutes, and their urinary recovery were 67-90%. 3. Clinically, CFX was given to the 29 children with a total of 31 of varying bacterial infections: 6 cases of urinary tract infection (U.T.I.), 19 of respiratory tract infection (R.T.I.), 2 of staphylococcal scalded skin syndrome (S.S.S.S.), 2 of purulent lymphadenitis and 2 cases of soft tissue dermatological infections. Overall efficacy rate was 83.9% (26 cases). No significant adverse reaction was noted except for 1 case of rash. Abnormal laboratory findings observed were elevation of GOT and GPT in 1 patient and of GPT in 1 patient.

Topics: Adolescent; Age Factors; Bacteria; Bacterial Infections; Cefoxitin; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Injections, Intravenous; Male

The antimicrobial activity of cefoxitin against clinical isolated organisms was measured: Cefoxitin was more active than cefazolin and cephalothin against Escherichia coli. The serum concentrations of cefoxitin following intravenous injection of 25 mg/kg were 267.7, 38.8, 8.3 microgram/ml at 5, 30, 120 minutes after injection, respectively. Cefoxitin was excreted 90.5% in urine within 6 hours after injection. Cefoxitin was administered clinically to 22 pediatric patients with various infections (urinary tract infection 9, respiratory tract infection 10, S.S.S.S. 1, Salmonella enteritis 1, and cervical lymphadenitis 1) at the dose of 45-98 mg/kg/day for 4-10 days, and the following satisfactory results were obtained; excellent in 16, good in 5, and poor in 1. The rate of satisfactory clinical response was 95.5%. Slight elevation of transaminase and A1-P were observed in 4 patients, but no other serious side effects were observed.

Topics: Adolescent; Age Factors; Bacteria; Bacterial Infections; Cefoxitin; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Injections, Intravenous; Male

Studies on antimicrobial activity, absorption and excretion and clinical use of cefoxitin in pediatric field were performed. 1. MIC of cefoxitin was compared with that of cefazolin and/or ampicillin for clinical isolates of Staphylococcus aureus (36 strains), Escherichia coli (35 strains), Klebsiella pneumoniae (34 strains) and Haemophilus influenzae (80 strains). MIC of cefoxitin against S. aureus was approximately 1-2 tubes higher than that of cefazolin. Many strains of E. coli and K. pneumoniae that showed high MIC to cefazolin were sensitive to cefoxitin. It is presumed that the results are due to the strong resistance of cefoxitin to beta-lactamase degradation. MIC of cefoxitin against H. influenzae was approximately 1-2 tubes lower than that of cefazolin, but approximately 4 tubes higher than that of ampicillin. 2. Serum level and urinary recovery rate of cefoxitin after one shot i.v. injection of 25 mg/kg were examined. The serum mean levels were 33.8 microgram/ml at 1/2 hour, 7.0 microgram/ml at 1 hour and 2.9 microgram/ml at 2 hours after the injection, respectively, and the drug was not detected in serum at 4 and 6 hours after the injection. The mean half-life of serum level was 27.1 minutes. The mean urinary recovery rate within 6 hours after injection was 96.0% and most of the drug were excreted into urine within 2 hours after the injection. 3. In order to evaluate clinical response, bacteriological response and side effects, cefoxitin was applied to 19 cases, i.e., 12 cases of either acute lobar pneumonia or acute bronchopneumonia, 2 cases of acute pyelitis, 1 case each of acute bronchitis, acute purulent tonsillitis, acute purulent arthritis, acute orbital phlegmon and acute buccal abscess. As for clinical response, the overall efficacy rate (the percentage of cases showed excellent and good efficacy) was 88.9%. As for bacteriological response, among the 13 strains which were determined or supposed to be causative organisms, i.e., 6 strains of Streptococcus pneumoniae, 2 strains of H. influenzae and 1 strain each of streptococcus pyogenes, alpha-Streptococcus, Enterococcus, E. coli and Neisseria sp., all strains were disappeared except for Enterococcus which was reduced by the treatment with cefoxitin. No side effect was observed in any case. Abnormalities of laboratory findings were observed in 3 cases, i.e., 1 case each of reduction of RBC and Hb, elevation of GOT and GPT and elevation of GPT, but all of them returned to normal following c

Topics: Age Factors; Bacteria; Bacterial Infections; Cefoxitin; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Injections, Intravenous; Male

Clinical trials of cefoxitin, a new cephamycin antibiotic were carried out on 17 infantile patients with infections (respiratory tract infection 15, meningitis 1 and sepsis 1). Two patients of the above patients were excluded from the clinical evaluation except side effects because diseases were out of the object of this study. Cefoxitin was given at a dose of 50-104 mg/kg/day q.i.d. except 1 patient (b.i.d.) by a single intravenous injection for 2-27 days. The clinical efficacy obtained was good in 11 patients, fair in 2 patients and poor in 2 patients. The efficacy rate was 73.3%. Side effects were observed in 4 patients (eosinophilia 1, skin rash 2 and transient elevation of GOT, GPT and LDH 1).

Topics: Age Factors; Bacterial Infections; Cefoxitin; Child; Child, Preschool; Drug Evaluation; Female; Humans; Infant; Injections, Intravenous; Male

The authors have carried out the laboratory and clinical studies of cefoxitin. The results were as follows: The sensitivity was estimated by plate dilution method on 26 strains of S. aureus, 25 strains of E. coli, 24 strains of K. pneumoniae, 27 strains of Serratia and 17 strains of Salmonella isolated from patients. The distribution of sensitivity of S. aureus was 1.56-3.13 microgram/ml and the peak of distribution was 3.13 microgram/ml. The strains of 76.0% of E. coli was inhibited at concentration of less than 3.13 microgram/ml. The strains of 91.7% of K. pneumoniae was inhibited at concentration of less than 3.13 microgram/ml. The distribution of sensitivity of Serratia was 6.25-more than 100 microgram/ml and the peak of distribution was 100 microgram/ml. The all strains of Salmonella were inhibited at concentration of less than 3.13 microgram/ml. Cefoxitin was given by intravenous administration for 5 minutes at a single dose of 25 mg/kg of cefoxitin to 2 children, and by drip infusion for 60 minutes at a single dose of 25 mg/kg of cefoxitin to 4 children. After intravenous administration of cefoxitin, the mean peak of serum level was 67.3 +/- 6.3 microgram/ml at 15 minutes, and at 4 and 6 hours after administration was not detected. Half-life time was 22 minutes. And after drip infusion of cefoxitin for 60 minutes, the mean peak of serum level was 35.7 +/- 5.3 microgram/ml at 1 hour, and at 4 and 6 hours after administration was not detected. Half-life time was 20 minutes. The mean urinary recovery rate was 82.4 +/- 3.0% and 90.2 +/- 6.8% up to 6 hours after intravenous administration and drip infusion respectively. Cefoxitin was effective in all of 15 cases with bacterial infections. No side effects was observed.

Topics: Adolescent; Age Factors; Bacteria; Bacterial Infections; Cefoxitin; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Injections, Intravenous; Male

Fundamental and clinical evaluations were made on cefoxitin, a new cephamycin antibiotic, and the following results were obtained. 1) MIC of the drug to clinical isolates was determined and was higher than that of cefazolin to Gram-positive bacilli. Among Gram-negative rods, the drug showed a sufficient antibacterial activity even to cefazolin-resistant strains. However, the MIC of cefoxitin to cefazolin-sensitive strains tended to be higher than that of cefazolin. 2) As to the passage of cefoxitin in experimental staphylococcal meningitis in rabbits, a percentage of CSF/serum ratio of AUC was 10.7% up to 3 hours and CSF/serum ratio of T1/2 was 1.78 of which value was an intermediate between those of ampicillin and cefazolin. There were, however, larger individual differences. 3) Blood concentrations and urinary recovery rates were determined in 2 children. In 1 patient, in whom the drug was given intravenously at a dose of 25 mg/kg, a blood concentration after 30 minutes was 50 microgram/ml, T1/2 was 57.2 minutes. This patient, however, showed a slight renal dysfunction. In another patient, who received an intravenous injection of 12.5 mg/kg, a 30 minutes blood concentration was 14.6 microgram/ml and T1/2 was 31.8 minutes. Urinary recovery rates up to 6 hours were 85.8% and 73.5%, respectively. 4) Thirty patients with the following bacterial infections were treated with cefoxitin, i.e., urinary tract infection (24 cases), respiratory tract infection (4 cases), each one case of peritonitis and suspected sepsis. An overall efficacy rate was 93.3%, i.e., excellent in 13 cases, good in 15, and failure in 2. Disappearance rate of the causative organism of the 23 clinical isolates was 87.0%, i.e., that the causative organism disappeared in 20 strains, reduced in 1 and persisted in 2. 5) Based on the above results, it was concluded that cefoxitin is a potent new antibiotic in bacterial infections in children, particularly respiratory and urinary tract infections. The optimal recommended dose will be about 25 mg/kg which should be given 3-4 times daily intravenously or by drip infusion.

Topics: Adolescent; Age Factors; Animals; Bacteria; Bacterial Infections; Cefoxitin; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Male; Rabbits

Laboratory and clinical studies of CFX were conducted on 30 pediatric inpatients at the Department of Pediatrics of Mie University. The results of the sensitivity evaluation conducted on 37 clinical isolates consisting of 16 species were in accordance with the findings reported hitherto in the literature, i.e., CFX was superior to CEZ and CET in terms of the growth inhibitory effect against Gram-negative rods. The serum peak level was obtained 5 minutes after an intravenous injection of 25 mg/kg, and 15 minutes after a drip infusion of 30 minutes using the same dose. The average terminal half life was 13 minutes 15 seconds for the former and 20 minutes for the latter. Clinical evaluation was made on a total of 22 eligible patients. The results were classified as follows: Excellent in 4 cases, good in 12, fair in 4 and poor in 2. The effective rate of CFX was 72.7%. Side effects observed were vascular pain, rash and vomiting, all of which were mild in nature and disappeared immediately after discontinuation of, or change in the routine of drug administration.

Topics: Age Factors; Bacteria; Bacterial Infections; Cefoxitin; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Injections, Intravenous; Male

Cefoxitin was given intravenously to 20 children with the following acute bacterial infections: 10 cases of bronchopneumonia, 6 cases of urinary tract infection, 2 cases of cervical purulent lymphadenitis, 1 case of streptococcosis and 1 case of omphalitis. Clinical effectiveness was obtained in 16 cases out of 20 cases and bacteriological effectiveness in 11 strains out of 15 strains. No side effect was observed except for 1 case with eruption and 1 case with slight elevation of GOT. From the above clinical results, it is apparent that cefoxitin is a useful antibiotic for treating pediatric patients with various kinds of bacterial infections.

Topics: Age Factors; Bacteria; Bacterial Infections; Cefoxitin; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Injections, Intravenous; Male

Using a new cephamycin antibiotic, cefoxitin, clinical studies were carried out, and the following results were obtained: (1) Cefoxitin was administered to 52 children with 38 respiratory tract infections, 2 urinary tract infections, 1 acute otitis media and others, who ranged in age from 2 months to 11 years old. (2) Cefoxitin was given intravenously at a daily dose of 27.3 mg/kg to 110.5 mg/kg. (3) The overall efficacy rate was 80% in 46 cases, i.e., excellent in 10, good in 27, fair in 7 and poor in 2. (4) Clinical side effects were not seen except exanthema in 1 patient. Elevation of GOT and GPT was seen in 2 patients, elevation of A1-P in 1 and eosinophilia in 2 by laboratory tests. However, these findings were alleviated rapidly following the cessation of therapy.

Topics: Age Factors; Bacterial Infections; Cefoxitin; Child; Child, Preschool; Drug Evaluation; Female; Humans; Infant; Injections, Intravenous; Male

1. The in vitro antibacterial activity of cefoxitin was nearly equal to that of CEZ and CET against the 6 species of clinically isolated strains. Cefoxitin, furthermore, had an antibacterial activity against the strains of P. morganii resistant to CEZ and CET. 2. Cefoxitin was applied to a total of 17 patients including 6 cases of bronchitis, 5 of pneumonia, 2 of enteritis, and 1 each of pharyngitis, laryngitis, sinusitis and lymphadenitis. The results showed an efficacy rate of 88%. In the 6 patients from whom the isolation of pathogenic organisms was possible, the bacteriological response to cefoxitin was appreciable the efficacy rate being 83%. Thus, it is considered that cefoxitin also has a significant antibacterial activity in vivo. 3. As to the side effects following the administration of cefoxitin, urticaria-like eruption was observed in 1 case, and an elevation of transaminase in another. These findings, however, became normal soon after discontinuation of cefoxitin treatment.

Topics: Adolescent; Age Factors; Bacteria; Bacterial Infections; Cefoxitin; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Male

In order to ascertain the therapeutic effects of cefoxitin (CFX), a new semisynthetic cephamycin antibiotic, it was administered to pediatric patients with several infections. There were 8 patients with acute respiratory disease (ARD), 3 with urinary tract infection (UTI), 2 with appendicitis complicated with peritonitis, 2 with scarlet fever, one each of left coxitis, infected medial cervical cyst, febrile illness after a V-P shunt operation, purulent parotitis and intractable diarrhea with fever, namely, a total of 20 patients aged from one month to 11 years 6 months. A CFX vial which contained 1 g of CFX was used in two ways, i.e., one shot intravenous injection and drip infusion. The dosage of the drug varied from 57 to 121 mg/kg/day and the administration was continued from 2 to 20 days. Clinical effects were evaluated as follows: when cardinal symptoms disappeared within 3 days it was considered to be 'excellent'; within 5 days 'good'; and no change of clinical symptoms within 5 days 'poor'. The bacteriological effect was expressed as 'eliminated', 'unchanged' and 'undetermined'. Clinical efficacy evaluated as 'excellent' occurred in 11 cases, 'good' in 8 cases and 'poor' in 1 case, the efficacy rate being 95.0%. When classified by the disease, the efficacy rate was as follows: 'good' to 'excellent' in 7 out of the 8 cases of ARD, 'excellent' in all of the 3 cases of UTI, 'good' and 'excellent' in the 2 cases of scarlet fever and in the 2 cases of peritonitis, 'excellent' in each case of left coxitis, purulent parotitis and intractable diarrhea with fever, 'good' in each case of infected medial cervical cyst and febrile illness with a V-P shunt operation. From the bacteriological point of view, 'eliminated' occurred in 5 cases, 'reduced' in 1 case and 'undetermined' in the 2 cases of ARD, 'eliminated' in all of the 3 cases of UTI, 'eliminated' in 1 case and 'undetermined' in the 1 case of peritonitis, 'undetermined' in the 2 cases of scarlet fever, 'eliminated' in each case of infected medial cervical cyst and purulent parotitis and 'undetermined' in the other cases. Antimicrobial efficacy measured by MIC was compared with CEZ and CET, and the results were as follows: CFX was inferior to the two cephalosporins for S. aureus, it was between CEZ and CET for H. influenzae and H. parainfluenzae, and CFX was superior to CEZ and CET for E. coli. All of the 3 antibiotics had poor antimicrobial efficacy for P. aeruginosa and S. faecalis. There were neither

Topics: Age Factors; Bacteria; Bacterial Infections; Cefoxitin; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Injections, Intravenous; Male

Pharmacokinetics of cefoxitin, a new injectable semisynthetic-cephamycin, was studied in 12 healthy children and also was studied cerebrospinal fluid levels in 1 patient with bacterial meningitis received 44.5 mg/kg of cefoxitin and thoracic fluid levels in 2 patients were measured. Cefoxitin was administered intravenously to 50 patients with various types of infections an average dose of 130 mg/kg/day for an average of 9 days. The results were as follows: 1. Favorable plasma levels were obtained comparing with those off conventional injectable cephalosporins after 15 mg/kg and 25 mg/kg of cefoxitin for one shot intravenous injection. The half lives of cefoxitin in the plasma were about 15.9 minutes up to 1 hour and 25.5 minutes up to 2 hours after an intravenous administration of cefoxitin at a dose of 15 mg/kg, and while, those were 15.9 minutes and 27.5 minutes after an intravenous administration of cefoxitin at a dose of 25 mg/kg, respectively. 2. Cefoxitin was excreted with high concentration up to 2 hours after the administration and thereafter, urinary concentration of cefoxitin declined rapidly with the lapse of time. The time course urinary concentration reflected those of plasma levels. Approximately 94.7% and 90.6% of dosed cefoxitin were recovered in the urine for 6 hours after the administration at the dose of 15 mg/kg and 25 mg/kg, respectively. 3. The cerebrospinal fluid levels of cefoxitin were only determined in a patient of bacterial meningitis. Therefore, further study should be performed. 4. The thoracic fluid levels with 2 patients were higher than cerebrospinal fluid levels. 5. Among the 50 patients with various infections, cefoxitin was clinically effective in 84% and bacterial response in 87%. 6. As adverse reactions, in total 79 patients included exclusive 29 patients, diarrhea occurred in 1 patient, sweating and cough in 1 patient, rash with fever in 4 patients, vascular pain in 2 patients, and leukopenia was observed in 1 patient, eosinophilia in 1 patient, and increase of GOT and LDH were observed in each 2 patients. The other adverse reactions were not experienced.

Topics: Adolescent; Age Factors; Bacterial Infections; Cefoxitin; Child; Child, Preschool; Drug Evaluation; Female; Humans; Infant; Kinetics; Male

Topics: Adult; Aged; Bacteria; Bacterial Infections; Cefoxitin; Drug Evaluation; Drug Resistance, Microbial; Female; Genital Diseases, Female; Humans; Middle Aged; Urinary Tract Infections

Topics: Adult; Aged; Bacteria; Bacterial Infections; Cefoxitin; Drug Evaluation; Drug Resistance, Microbial; Female; Hematologic Diseases; Humans; Immunosuppression Therapy; Male; Middle Aged

This clinical trial was designed to evaluate the efficacy, safety and patient tolerance of cefoxitin in 23 patients who were admitted to the hospital from March 1980 to November 1980. The daily dose of cefoxitin for 21 adult patients (ages ranged from 26 to 74 years old) were 6 g for the treatment of infections, and 2 to 6 g for the prevention of infections by either direct or intermittent intravenous infusions. Two children were given 100 mg/kg of cefoxitin either by direct or intermittent intravenous infusions 2 to 3 times a day in divided doses.. I. Treatment of intracranial infections 1. A 60-year-old man with a brain abscess was admitted to the hospital after the unsuccessful treatment with a cephalothin for 9 days. After, the initiation of therapy with cefoxitin, given 6 g a day for 3 days, the abscess was surgically removed. On the second day of treatment with cefoxitin following the operation, his highest temperature was 37.0 degrees C and was normal on the third day of treatment. He was discharged after 12 days after the surgical procedure. 2. A 56-year-old woman with cerebrospinal rhinorrhea and meningitis after the transsphenoidal removal of pituitary microadenoma responded satisfactorily to therapy with cefoxitin, given 6 g a day for 14 days after the unsuccessful treatment with a cephalothin. II. The prevention of infections following surgical operation of the central nervous system 1. Seventeen patients undergoing surgical procedures were treated with cefoxitin for the prevention of postoperative infections. None of the 17 patients developed postoperative infections. 2. A 53-year-old man undergoing repair of cerebrospinal rhinorrhea in the possibly contaminated area was successfully treated with cefoxitin, given intravenous 2 g every 8 hours for 10 days without meningitis having developed. III. The treatment and prevention of complications 1. A 74-year-old comatose male with a brain stem concussion, who was expectorating insufficiently and had difficulty swallowing and developed into pneumonia as a complication. He was successfully treated with cefoxitin, given intravenous 6 g a day for 2 weeks. 2. A 26-year-old male with a brain stem concussion complicated by pneumonia and a urinary tract infection was successfully treated with the same dose regimen of cefoxitin as the previous patient. 3. The prevention of complications A 58-year-old male with pontine glioma undergoing a tracheotomy was administered cefoxitin for the prevention of pulmonary complication. He died of pontine glioma after the three-month treatment. IV. Side effects Results of skin sensitivity tests given prior to the administration of cefoxitin were negative in all of the 23 patients. Neither anaphylaxis nor other allergic reactions or thrombophlebitis occurred with the intravenous administration of cefoxitin. No abnormalities in blood, hepatic function or renal function were observed. Anorexia occurred in 1 patient who was given cefoxitin, 6 g a day.

Topics: Adult; Aged; Bacterial Infections; Brain Diseases; Cefoxitin; Child; Female; Humans; Infusions, Parenteral; Injections, Intravenous; Male; Middle Aged; Premedication; Surgical Wound Infection

Topics: Adult; Aged; Bacterial Infections; Cefoxitin; Female; Humans; Kidney Diseases; Kidney Failure, Chronic; Male; Middle Aged; Renal Dialysis; Urinary Tract Infections

Specimens received at a district laboratory over a period of 4 months were investigated for determination of the sensitivities of common pathogens to 4 cephalosporins, ampicillin and mecillinam. A total of 1035 freshly isolated clinically significant organisms was studied. When sensitivities of all pathogens were considered, the majority were found to be resistant to ampicillin and mecillinam and sensitive to the cephalosporins. Sensitivity figures changed considerably when individual groups of organisms were considered. The great majority of urinary pathogens were sensitive to mecillinam, but not to ampicillin. This pattern was reversed when respiratory pathogens were considered. Only a few pathogens from wound swabs were sensitive to either ampicillin or mecillinam. All the cephalosporins tested showed much wider spectrum of activities. Of all antibiotics tested, only cefoxitin was active against the vast majority of Bacteroides spp. These findings are discussed in relation to the clinical uses of these antibiotics.

Topics: Amdinocillin; Ampicillin; Bacterial Infections; Cefamandole; Cefoxitin; Cefuroxime; Cephalexin; Cephalosporins; Humans; Microbial Sensitivity Tests; Penicillanic Acid

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

Topics: Adult; Aged; Bacteria; Bacterial Infections; Cefoxitin; Digestive System Diseases; Drug Evaluation; Drug Resistance, Microbial; Humans; Male; Middle Aged

Topics: Acute Disease; Adult; Amikacin; Bacterial Infections; Cefoxitin; Drug Therapy, Combination; Humans; Infusions, Parenteral; Kanamycin; Leukemia; Lincomycin; Middle Aged; Penicillins; Ticarcillin

Topics: Anti-Bacterial Agents; Bacterial Infections; Cefoxitin; Cefuroxime; Humans; Lung Diseases; Postoperative Complications; Respiratory Tract Infections; Surgical Procedures, Operative

Topics: Adult; Aged; Bacteria; Bacterial Infections; Cefoxitin; Humans; Middle Aged

Cefoxtin sodium is a new semisynthetic cephamycin antibiotic derivative of cephamycin-C. It has a broad antibacterial spectrum in vivo and in vitro that includes all strains of cephalosporin-sensitive bacteria and the majority of cephalosporin-resistant bacteria. A double-blind (cefoxitin and placebo) study was instigated in premenopausal women undergoing vaginal hysterectomy at Louisiana State University Gynecologic Service. There were 152 patients, of whom 125 completed the study. The objective of the study was to determine the clinical effectiveness of cefoxitin as a safe prophylactic antibiotic. Both placebo and cefoxitin groups were from the authors' clinic, and thus there were no major clinical differences among patients. The cefoxitin-treated group had a 10.3% major morbidity as compared to 29.8% in the placebo group. Cefoxitin was well tolerated and there were no adverse reactions in any of the patients.

Topics: Adult; Bacterial Infections; Cefoxitin; Cervix Uteri; Double-Blind Method; Female; Humans; Hysterectomy; Hysterectomy, Vaginal; Placebos; Postoperative Complications; Vagina

The penetration of cefoxitin into cerebrospinal fluid (CSF) was studied in 25 patients with purulent meningitis treated with antibiotics other than cefoxitin. Each patient received three 2-g doses of cefoxitin at 6-h intervals. Blood and CSF samples were obtained before and at 2, 4, or 6 h after the first and third doses. CSF cefoxitin concentrations were found in all patients and varied between 1.2 and 22.0 microgram/ml, with a majority of the concentrations falling within a range from 1.2 to 6.2 microgram/ml. The concentrations tended to be higher in CSF samples drawn after the third cefoxitin dose than in those drawn after the first cefoxitin dose, indicating an accumulation of cefoxitin in CSF with repeated doses. Peak cefoxitin concentrations in CSF seemed to occur between 2 and 6 h after intravenous administration of the drug since the highest concentrations were found in patients from whom CSF samples were taken 4 h after the doses. In patients with bacterial meningitis, it should be possible to achieve therapeutic cefoxitin levels in CSF by using nontoxic doses of the antibiotic.

Topics: Adult; Aged; Bacterial Infections; Biological Transport; Cefoxitin; Female; Humans; Kinetics; Male; Meningitis; Middle Aged; Time Factors

Thirty-two infants and children ranging in age from 3 to 151 months (mean, 26 months) were treated with parenteral cefoxitin (150 mg/kg per day). Ten patients with isolates of Haemophilus influenzae (six with cellulitis, two with arthritis, and two with mastoiditis), four with Staphylococcus aureus (one with lymphadenitis, one with septicemia, and two with abscess), and three patients with Streptococcus pneumoniae (one each with cellulitis, abscess, and arthritis), were clinically and bacteriologically cured by therapy. Two additional patients with septic arthritis and facial cellulitis developed meningitis with H. influenzae type b and S. pneumoniae, respectively. Minimal inhibitory and bactericidal concentrations were 20 mug/ml for one strain of S. aureus and one of H. influenzae type b. The mean peak serum levels were 81.9 and 68.5 mug/ml 15 min after intravenous or intramuscular doses, respectively. The mean elimination half-lives were 42.4 and 40.1 min after intravenous or intramuscular doses, respectively. The mean volumes of distribution were 5,540 and 4,760 ml after intravenous and intramuscular doses, respectively. Mean plasma clearance was 242 and 257 ml/min per m(2) after intravenous and intramuscular doses, respectively. Therapy was discontinued in one patient because of neutropenia, which resolved after cefoxitin was stopped. Eosinophilia and transiently elevated liver function tests occurred in eight and six patients, respectively. These data indicate that cefoxitin may be an effective treatment for infections due to susceptible bacteria in the dosage tested, but its use may be limited because of the occurrence of meningitis during therapy in some patients.

Topics: Adolescent; Aspartate Aminotransferases; Bacterial Infections; Cefoxitin; Child; Child, Preschool; Female; Humans; Infant; Influenza, Human; Injections; Kinetics; Male; Meningitis; Microbial Sensitivity Tests

The concentrations of cefoxitin in serum and cerebrospinal fluid (CSF) were measured simultaneously in three groups of patients, 12 with aseptic meningitis (group 1) and 17 and 14 with bacterial meningitis (groups 2 and 3). The patients in group 1 received a single intravenous dose of 2 g of cefoxitin without other antimicrobial therapy. In addition to conventional doses of ampicillin or benzyl penicillin, patients in groups 2 and 3 received repeated infusions of 2 g of cefoxitin every 4 h for the first 3 or 4 days of the study and again on day 10. Additionally, group 3 received probenecid in a loading dose of 1 g followed by 0.5 g every 6 or 8 h. Concentrations of cefoxitin in CSF and serum were determined 1 or 2 h after infusion in group 2 and 2 h after infusion in group 3. The concentrations of cefoxitin in CSF did not reach detectable levels (1.56 microgram/ml) in 11 of the 12 patients in group 1. A level of 2.8 microgram of cefoxitin per ml of CSF was found, with an accompanying level of 30 microgram/ml of serum, in patient 12. In the group 2 patients with bacterial meningitis, the mean CSF concentrations were 3.3, 4.7, and 2.9 microgram/ ml on days 1, 3, and 10 of treatment, with simultaneous serum levels of 8, 9, and 8 microgram/ml. At similar times periods, the mean levels of cefoxitin in group 3 patients (with concomitant probenecid) were 8.6, 12.3, and 4.3 microgram/ml of CSF and 57, 35, 27 microgram/ml of serum.

Topics: Adolescent; Adult; Age Factors; Aged; Bacterial Infections; Blood Urea Nitrogen; Cefoxitin; Humans; Kidney; Meningitis; Meningitis, Aseptic; Middle Aged; Probenecid; Time Factors

Topics: Adult; Bacterial Infections; Biological Assay; Cefoxitin; Chromatography, High Pressure Liquid; Humans; Kinetics

To determine the unbiased incidence and types of postoperative infection and their alteration(s) by antimicrobial prophylaxis, a prospective double-blind study was performed using perioperative intramuscular cefoxitin or placebo given to premenopausal women undergoing vaginal hysterectomy at Parkland Memorial Hospital. The clinical and surgical profiles of the 2 groups of women were similar, but there were marked differences in their postoperative clinical courses. Only 8% of the 50 women given cefoxitin had major postoperative infection, compared to 57% of the 49 women given placebo (P < .001); this was associated with a 2.8-day reduction in the hospital stay for those given cefoxitin (P < .001). No clinically significant side effects were observed.

Topics: Adult; Bacterial Infections; Cefoxitin; Double-Blind Method; Female; Hospitalization; Humans; Hysterectomy, Vaginal; Menopause; Middle Aged; Placebos; Postoperative Complications; Premedication; Prospective Studies

Cefoxitin is a useful new chephamycin antibiotic available for IM of IV administration. It is a bactericidal beta-lactam antibiotic indicated for treatment of serious infections caused by a wide spectrum of gram-negative aerobic and anaerobic bacteria. Specific indications include: 1) polymicrobial infections (aerobic gram-negative rods and anaerobic bacteria); 2) nosocomial cephalothin-resistant gram-negative bacillary infections; 3) penicillin-resistant staphylococcal infections, and 4) anaerobic infections (pelvic, intraabdominal). Cefoxitin can be used as a single drug alternate to a two-drug antibiotic regimen (such as a cephalosporin-aminoglycoside combination) in polymicrobic infections of the pelvis, abdomen, skin, bones, or muscles. Cefoxitin is a significant drug in the armamentarium against anaerobic bacteria, particularly Bacteroides species. Since cefoxitin is highly resistant to staphylococcal beta-lactamase, it is effective against penicillin-resistant staphylococci. Cefoxitin has been effective in treating serious nosocomial infections caused by resistant aerobic gram-negative rods and anaerobic bacteria.

Topics: Bacteria; Bacterial Infections; Cefoxitin; Female; Humans; Infant; Infant, Newborn; Pelvic Inflammatory Disease; Surgical Wound Infection; Urinary Tract Infections

Topics: Aged; Bacteria; Bacterial Infections; Cefoxitin; Cephalothin; Drug Resistance, Microbial; Female; Humans; Male; Middle Aged; Surgical Wound Infection

Topics: Bacteria; Bacterial Infections; Cefoxitin; Humans

Topics: Bacterial Infections; beta-Lactamases; Cefoxitin; Cephalosporins; Drug Evaluation; Drug Resistance, Microbial; Microbial Sensitivity Tests

Topics: Bacteria; Bacterial Infections; Cefamandole; Cefoxitin; Cephalosporins; Costs and Cost Analysis; Haemophilus influenzae; Humans

Agar minimal inhibitory concentrations and mouse protection test effective doses were determined for each of four beta-lactam antibiotics against each of 12 Gram-negative and 3 Gram-positive bacterial cultures. The beta-lactamase activity of these cultures also was studied. The data were examined to determine whether relative in vivo efficacies could be predicted from relative in vitro activities. Although such predictions were quite accurate for cefoxitin and cefazolin, this was not true for cefamandole or for cephalothin. Such poor predictability was not necessarily associated with the susceptibility of these cephalosporins to hydrolysis by bacterial beta-lactamases. Although the clinical significance of these observations is not known, these data emphasize that relative in vitro activities should be used only with caution to estimate in vivo efficacies, since not all compounds show the excellent predictability observed here for cefazolin and cefoxitin.

Topics: Animals; Bacteria; Bacterial Infections; beta-Lactamases; Cefamandole; Cefazolin; Cefoxitin; Cephalosporins; Cephalothin; Female; Hydrolysis; Mice

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

Topics: Anti-Bacterial Agents; Bacterial Infections; beta-Lactams; Cefoxitin; Enterobacteriaceae Infections; Humans

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

Cefoxitin, a parenteral cephamycin beta-lactam antibiotic, was evaluated for safety and efficacy in children with bacterial infections other than meningitis. Twentysix patients between 3 months and 7 years of age were treated with 80 to 160 mg/kg per day. The most common diagnoses were cellulitis (13 patients), pneumonia (5 patients), and bone and joint infection (4 patients). Nine patients were bacteremic. The most frequently recovered pathogens were Staphylococcus aureus (six patients), Haemophilus influenzae (four patients), and Streptococcus pneumoniae (three patients). All organisms were susceptible to cefoxitin. All 26 children were considered improved or cured. No severe adverse reactions were encountered. Phlebitis (4%), eosinophilia (12%), and elevated liver function tests (4%) were associated with therapy. Cefoxitin appears to be a safe, effective, and well-tolerated antibiotic when used in children with susceptible bacterial infections other than meningitis.

Topics: Bacterial Infections; Cefoxitin; Child; Child, Preschool; Drug Evaluation; Female; Humans; Infant; Male; Microbial Sensitivity Tests

Topics: Anaerobiosis; Anti-Bacterial Agents; Bacterial Infections; Brain Diseases; Cefoxitin; Clindamycin; Gastrointestinal Diseases; Humans; Metronidazole; Penicillins; Postoperative Complications; Respiratory Tract Infections

Topics: Aerobiosis; Anaerobiosis; Bacterial Infections; Cefoxitin; Cephalosporins; Female; Humans; Male

Cefoxitin, a new semi-synthetic cephamycin, has been studied in the treatment of patients with a variety of infections. Included have been a number of patients who have impaired renal function. The drug proved to be effective in treating gram-positive, gram-negative and anaerobic infections, and can be given by the intravenous or intramuscular route. Adverse effects occurred in six of 34 patients. These were not usually serious. The presence of renal failure did not interfere significantly with the efficacy of cefoxitin in treating urinary tract infection and it is considered, in contrast to the aminoglycosides, that this preparation can be used successfully without the necessity for measuring blood or urine levels in patients with reduced or unknown renal function.

Topics: Adult; Aged; Bacterial Infections; Cefoxitin; Cephalosporins; Female; Humans; Injections, Intramuscular; Injections, Intravenous; Kidney Diseases; Male; Middle Aged

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefazolin; Cefoxitin; Cephalothin; Drug Resistance, Microbial; Humans; Middle Aged; Wound Infection

We have studied cefuroxime, a new beta-lactamase resistant cephalosporin, and cefoxitin, the first cephamycin antibiotic, which is also resistant to many beta-lactamases. Both of these antibiotics have been shown to be microbiologically superior to the "first generation" cephalosporins, cefuroxime having notable activity against Haemophilus influenzae, and cefoxitin against Bacteroides fragilis. Neither antibiotic is absorbed from the gut but, following parenteral administration, serum, urine and bile concentrations are high. Clinical trials have been conducted on both cefoxitin and cefuroxime. The results of these have been satisfactory and untoward side-effects minimal. We suggest that cefoxitin will be particularly valuable in the management of abdominal sepsis and cefuroxime in infections caused by H. influenzae.

Topics: Bacterial Infections; Bacteroides fragilis; Cefoxitin; Cephalosporins; Drug Resistance, Microbial; Furans; Haemophilus influenzae; Humans; Microbial Sensitivity Tests

A spectrum of new and commonly used antibiotics was examined with regard to their ability to penetrate into joint fluid in normal and E. coli infected rabbit knee joints. In order to carry out this investigation a new, simple method of measuring antibiotics in very small amounts of synovial fluid was developed. Cephalothin, cefazolin, cefoxitin, carbenicillin, amikacin, and gentamicin all penetrated into synovial fluid effectively achieving peak concentrations within 30 minutes to one hour. Synovial fluid antibiotic concentrations at 2 hours were equal to or higher than simultaneous serum levels. This relationship persisted thereafter. Penetration of antibiotics into infected joints was dependent primarily on serum concentration and was not altered importantly by the presence of acute chronic or previous infection. Antibiotic doses employed were equivalent to clinical usage on a weight basis. Penetration of all antibiotics studied was satisfactory for use against their normally intended pathogens.

Topics: Amikacin; Animals; Anti-Bacterial Agents; Bacterial Infections; Carbenicillin; Cefazolin; Cefoxitin; Cephalothin; Escherichia coli Infections; Gentamicins; Humans; Joint Diseases; Knee Joint; Rabbits; Synovial Fluid

Topics: Bacterial Infections; Carbenicillin; Cefamandole; Cefazolin; Cefoxitin; Cephalosporins; Dose-Response Relationship, Drug; Escherichia coli Infections; Humans; Klebsiella Infections; Penicillins; Ticarcillin

The in vitro activity of cefazolin, cefoxitin und amikacin alone and in combination was determined via membrane filtration against E. coli (n = 2), K. pneumoniae (n = 2) and of cefoxitin and amikacin against Proteus vulgaris (n = 1). Therapeutically achievable concentrations of cefazolin (10 micrograms/ml), cefoxitin (10 micrograms/ml) and amikacin (10 micrograms/ml) lead to a rapid bactericidal effect against all of our strains. The combination of cefazolin (10 micrograms/ml) and amikactin (5 micrograms/ml) and cefoxitin (10 micrograms/ml and amikacin (5 micrograms/ml) was synergistic against only one of the 2 K. pneumoniae strains. Cefoxitin and amikacin were antagonistic against the P. vulgaris strain but synergistic against both E. coli strains.

Topics: Amikacin; Bacteria; Bacterial Infections; Cefazolin; Cefoxitin; Cephalosporins; Drug Synergism; Escherichia coli; Humans; Kanamycin; Klebsiella pneumoniae; Microbial Sensitivity Tests; Proteus vulgaris; Time Factors

Three semisynthetic cephamycin antibiotics (7alpha-methoxy-cephalosporins), SK&F 73678, SK&F 83088 (CS-1170) and cefoxitin, have been found to possess favorable biological and chemotherapeutic properties. All three cephamycins are active in vitro against strains of Staphylococcus aureus and a variety of gram-negative bacilli. Beta-lactamase producing organisms including indole-producing Proteus spp., Enterobacter spp. and Serratia strains as well as certain anaerobic bacteria were found to be susceptible to these antibiotics. SK&F 73768 showed somewhat better MIC values than cefoxitin against multiple strains of bacteria. Strains of Pseudomonas aeruginosa and group D streptococci are essentially insensitive to these compounds. Their binding to serum proteins is relatively low. In mice, cefoxitin showed the most favorable pharmacokinetics with respect to peak serum level, serum half-life and urinary recovery. These cephamycins protected mice experimentally infected with a variety of bacterial strains. All three compounds are rapidly bacteriolytic to the logarithmically growing Escherichia coli and belatedly so to Staphylococcus strains with complete sterilizing effect. SK&F 73678 and SK&F 83088 showed activity and potency comparable to or better than cefoxitin and thus can be considered candidates for clinical study.

Topics: Animals; Bacteria; Bacterial Infections; Cefoxitin; Cephalosporins; Cephamycins; Dose-Response Relationship, Drug; Drug Resistance, Microbial; Humans; Kinetics; Mice; Protein Binding

The pharmacokinetics of cefoxitin, a new cephamycin antibiotic, were studied in six patients who were undergoing total hip replacement, and who were given cefoxitin to provide prophylactic cover at the time of operation. Later, the efficacy of cefoxitin was studied in nine patients with severe acute infections. The mean elimination phase half-life of cefoxitin which was obtained in this study (83 to 87 minutes) was significantly longer than that obtained in other studies. Cefoxitin was also found to be effective in lung and urinary tract infections against sensitive organisms. It was well tolerated, and the only side effect was that of phlebitis in long-term therapy. Cefoxitin may be valuable for prophylactic use in bowel and orthopaedic surgery.

Topics: Aged; Bacterial Infections; Cefoxitin; Cephalosporins; Drug Evaluation; Female; Half-Life; Humans; Infusions, Parenteral; Male; Middle Aged

Topics: Bacteria; Bacterial Infections; Cefamandole; Cefazolin; Cefoxitin; Cephalexin; Cephaloridine; Cephalosporins; Cephalothin; Cephradine; Humans

Topics: Bacterial Infections; Cefoxitin; Cephalosporins; Humans; Osteomyelitis; Skin Diseases, Infectious

Topics: Adolescent; Adult; Bacterial Infections; Bone Diseases; Cefoxitin; Cephalosporins; Humans; Middle Aged; Muscular Diseases; Urinary Tract Infections

Topics: Bacterial Infections; Cefoxitin; Cephalosporins; Female; Genital Diseases, Female; Humans; Injections, Intravenous; Pregnancy; Pregnancy Complications, Infectious

Forty-two patients were treated with intravenous cefoxitin, a new cephamycin antibiotic. These patients had postoperative abdominal sepsis (26), intrathoracic infections (6), urinary tract infections (5), gram-negative bacterial meningitis (2), septic arthritis (1), epidural abscess (1) and isolated septicemia (1). The antibacterial spectrum of cefoxitin was found to be one which included all gram-positive organisms except enterococci, most gram-negative organisms except Pseudomonas aeruginosa, and almost all of the important anaerobic organisms. The only five treatment failures included one patient with empyema and one with septic arthritis, both caused by Serratia marcescens, initially only moderately susceptible to cefoxitin, which subsequently developed increased resistance, two patients with contaminated intravenous catheters, and one patient with epidural abscess and cerebritis, who was treated late in the course. There was one serious clinical superinfection with P. aeruginosa. The drug levels noted in the pus and joint fluid were half to two-thirds of the simultaneous serum level. In inflamed meninges, up to 30% of the serum level was noted in the cerebrospinal fluid, and as the process resolved, 10 to 15% was noted. Toxicity of cefoxitin was mild and constituted skin rash in three patients (7%) and phlebitis in eight (19%).

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefoxitin; Cephalosporins; Child; Drug Evaluation; Female; Gram-Negative Aerobic Bacteria; Gram-Negative Anaerobic Bacteria; Humans; Male; Middle Aged

Clinical and bacteriological efficacy, patient tolerance, and toxicity of cefoxitin, a beta-lactamase-resistant cephamycin, were evaluated in 38 patients; 13 had soft tissue infection, 12 had pneumonia, 3 had urinary tract infection, 2 had peritonitis, and 4 had miscellaneous infections. In five patients, infection was clinically evident, though not bacteriologically proven. The latter patients were evaluated with regard to tolerance and toxicity only. Among the 34 infections in 33 patients, 71% were considered clinically cured; 86% of those patients who could be recultured were bacteriologically cured. Phlebitis was noted in 32% of the total group, and eosinophilia was observed in 16%. Unexplained deterioration in renal function occurred in two patients. Mean peak cefoxitin levels in serum were 72 mug/ml 30 min after a 2-g infusion and 32 mug/ml 30 min after a 1-g infusion. Cefoxitin was more active against facultatively and obligately anaerobic gram-negative organisms isolated from these patients than was cephalothin.

Topics: Adult; Aged; Bacterial Infections; Cefoxitin; Cephalosporins; Drug Evaluation; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Peritonitis; Pneumonia; Urinary Tract Infections

Cefamandole is a new cephalosporin antibiotic that was tested in vitro against 540 clinical isolates of gram-positive cocci and gram-negative bacilli. A concentration of 0.39 mug/ml inhibited 95% of the isolates of Staphylococcus aureus. A concentration of 6.25 mug/ml inhibited over 90% of the isolates of Proteus mirabilis and Escherichia coli, 69% of the isolates of Klebsiella pneumoniae, and 31% of the isolates of indole-positive Proteus spp. and Enterobacter spp. It was active against most cephalothin-resistant isolates of E. coli but not of K. pneumoniae.

Topics: Bacteria; Bacterial Infections; Cefoxitin; Cephalexin; Cephalosporins; Cephalothin; Escherichia coli; Klebsiella pneumoniae; Proteus; Serratia marcescens; Species Specificity; Staphylococcus aureus; Streptococcus

Topics: Anaerobiosis; Anti-Bacterial Agents; Bacterial Infections; Cefoxitin; Chloramphenicol; Clindamycin; Humans; Metronidazole; Penicillins

The in vitro antibacterial effects of cefoxitin, a semisynthetic cephamycin, cefuroxime, a new cephalosporin antibiotic, and cephaloridine were compared. With gram-positive bacteria, marked differences were found only in the effects against Streptococcus faecalis, where cephaloridine and cefuroxime were superior to cefoxitin. With gram-negative aerobic bacteria, cefoxitin, which is known to be more resistant to beta-lactamases from gram-negative bacteria than any cephalosporin, was found to be more effective than cefuroxime and cephaloridine against ampicillin-resistant strains of Escherichia coli and indole-positive strains of Proteus. Haemophilus influenzae was found to be more susceptible to cefuroxime than to cefoxitin and cephaloridine. When ampicillin-resistant strains of H. influenzae were tested, markedly higher minimal inhibitory concentration values were obtained with cephaloridine in comparison to those obtained with ampicillin-susceptible strains. These increases in the minimal inhibitory concentration values were not observed with cefoxitin and cefuroxime, probably due to the resistance of these two compounds to beta-lactamases. Strains of Bacteroides fragilis were found to be much more susceptible to cefoxitin than to cefuroxime, which in turn was superior to cephaloridine. The results obtained indicate that cefoxitin and cefuroxime both are superior in their antibacterial spectra to the cephalosporins that are now in clinical use.

Topics: Bacteria; Bacterial Infections; Cefoxitin; Cephaloridine; Cephalosporins; Chemical Phenomena; Chemistry; Humans; Species Specificity