cefoxitin and Empyema

Controversy persists regarding the use of antibiotics in association with t tube thoracostomy for trauma patients. We conducted a prospective randomized study of patients requiring tube thoracostomy for pneumo- and/or hemothorax complicating blunt or penetrating thoracic trauma in an attempt to assess the efficacy of prophylactic antibiotic therapy. Fifty-eight patients were included in the study. The control group (Group I) included 28 patients who received no antibiotic therapy: the experimental group (Group II) included 30 patients who received cefoxitin (1.0 gm IV q 6 h) commencing before tube thoracostomy and terminating 12 hours after its removal. The incidence of infectious complications (pneumonia and/or empyema) was recorded. Among the patients not receiving antibiotics, eight of 28 (29%) developed infectious chest complications. Of the patients receiving antibiotics, there was one infectious complication (3%). This difference is statistically significant (p = 0.0227). Cultures demonstrated significant conversion from negative to positive both within each group and between groups. The organism most commonly recovered was S. aureus. Our findings strongly suggest that patients requiring tube thoracostomy for trauma, whether blunt or penetrating, should receive the benefit of systemic prophylactic antibiotic therapy.

Topics: Adolescent; Adult; Cefoxitin; Empyema; Female; Hemothorax; Humans; Intubation; Male; Middle Aged; Pneumonia; Pneumothorax; Premedication; Prospective Studies; Random Allocation; Thoracic Injuries

Topics: Abdomen; Cefoxitin; Drug Therapy, Combination; Empyema; Erythromycin; Gentamicins; Humans; Listeriosis; Male; Middle Aged; Pain; Pleural Effusion

Cefoxitin (CFX) was administered to 12 patients with respiratory tract infections, including mainly patients with pulmonary suppuration or pyothorax. The results were as follows: CFX was effective in 75% of the total patients, and in 83% of the 6 patients with pulmonary suppuration or pyothorax. Microorganisms which were considered to be causative were isolated in 8 of 12 patients. Bacteriological responses were "eradicated" in 4 patients, "replaced" in 3 patients, "unchanged" in 1 patient. A slight elevation of S-GPT was observed in one patient and elevation of A1-P in another following CFX administration; however, these values returned to normal shortly after completion of drug administration. No adverse effects, allergic symptoms or laboratory abnormalities were observed.

Topics: Adolescent; Adult; Aged; Alanine Transaminase; Cefoxitin; Drug Evaluation; Empyema; Female; Humans; Infusions, Parenteral; Lung Abscess; Male; Middle Aged; Respiratory Tract Infections

Topics: Cefoxitin; Clostridium Infections; Clostridium perfringens; Empyema; Humans; Male; Middle Aged; Penicillin G; Penicillin Resistance

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