cefoxitin and Gas-Gangrene

Of 152 patients who were scheduled for an amputation for ischemia, seventy-seven were randomly assigned to perioperative prophylaxis with cefoxitin (Mefoxin) and seventy-five patients, to injections of a placebo. The patients were followed for twenty-one days or, in the case of wound complications, to the end of treatment. An infected wound occurred in 38.7 per cent of the patients in the placebo group and 16.9 per cent of those in the antibiotic group (p less than 0.005). Clostridial infection occurred in eight patients in the placebo group and in none in the antibiotic group (p = 0.003). Three of the patients with clostridial infection died of gas gangrene. A multivariate analysis showed that the absence of antibiotic prophylaxis increased the risk of infection by a factor of 3.3 (p = 0.004) and increased the need for reamputation by a factor of 4.5 (p = 0.003). We concluded that amputation patients should have prophylaxis with a broad-spectrum antibiotic given perioperatively.

Topics: Adult; Aged; Amputation, Surgical; Arteriosclerosis; Cefoxitin; Clinical Trials as Topic; Female; Gas Gangrene; Humans; Leg; Male; Middle Aged; Premedication; Random Allocation; Risk; Staphylococcal Infections; Surgical Wound Infection; Time Factors

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cefoxitin; Child; Child, Preschool; Clindamycin; Clostridium; Clostridium bifermentans; Clostridium histolyticum; Clostridium perfringens; Clostridium septicum; Clostridium sordellii; Clostridium tertium; Drug Resistance, Bacterial; Female; Gas Gangrene; Humans; Hungary; Imipenem; Infant; Inhibitory Concentration 50; Male; Meropenem; Microbial Sensitivity Tests; Middle Aged; Penicillins; Retrospective Studies; Tigecycline; Young Adult

An investigation conducted on healthy volunteers showed that cefoxitin quickly reaches high plasma concentrations, and is almost completely excreted via the urine within 6 hours. In a series of 21 cases treated with 2 g i.v. in 100 ml of a 5% glucose solution two or three times a day, a clinical cure was achieved in 20, and marked improvement in the remaining patient.

Topics: Bacillus subtilis; Bronchitis; Bronchopneumonia; Cefoxitin; Cholangitis; Cystitis; Drug Evaluation; Drug Tolerance; Gas Gangrene; Herpes Zoster; Humans; Kinetics; Osteomyelitis; Sepsis

The clinical course and treatment of 21 critically ill patients suffering from gas gangrene are reported. Analysis of the results has underlined the importance of intensive care and hyperbaric management to prevent the evolution of disease and to improve patients' clinical conditions for surgical procedures.

Topics: Cefoxitin; Gas Gangrene; Gentamicins; Humans; Hyperbaric Oxygenation; Wound Infection