cefoxitin and Peritonitis

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

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

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

A comparison of single-agent antimicrobial therapy in the treatment of patients with perforated or gangrenous appendicitis and peritonitis was performed in a double-blind, randomized, prospective trial. Pathologic documentation of advanced appendicitis and positive intraoperative specimen cultures were required for inclusion in the study. Ceftizoxime (2 gm every 12 hours) and cefoxitin (2 gm every six hours) were compared. There were no significant differences between the treatment groups. Ninety-seven percent of patients treated with ceftizoxime and 89% of those treated with cefoxitin were cured or improved; there was no mortality in either group. By the use of optimal sampling, transport, and culture techniques, the number and diversity of bacteria recovered from these patients with advanced appendicitis were found to be much larger than previously suspected. Peritoneal fluid, abscess contents (if present), and appendiceal tissue (obtained so as to exclude the lumen) were cultured from all patients. An average number of 3.1 aerobic or facultative bacteria species and 8.5 anaerobic species were isolated from each specimen. Twenty-eight different genera and more than 55 species were encountered, including a previously undescribed fastidious gram-negative anaerobic bacillus. Bacteroides fragilis group and Escherichia coli were isolated from almost all specimens, and within the B fragilis group, eight species were represented. The recovery of such an unexpectedly large and diverse flora may be the reason for the therapeutic failures in these patients. We conclude that single-agent antimicrobial therapy in patients with advanced appendicitis and peritonitis is both safe and effective, and, with ceftizoxime, can be accomplished by a twice-daily dosing regimen.

Topics: Adult; Appendicitis; Bacteria, Aerobic; Bacteria, Anaerobic; Cefoxitin; Ceftizoxime; Double-Blind Method; Female; Gangrene; Humans; Intestinal Perforation; Male; Peritonitis; Randomized Controlled Trials as Topic; Rupture, Spontaneous

Two sequential randomised studies were performed to assess the efficacy of 3 different cephalosporins in the treatment of established intra-abdominal infections. In the first study 102 of 109 (94%) patients given cefotetan 2g iv every 12 hours had a satisfactory clinical response compared to 51 of 56 (91%) patients given latamoxef 2g iv every 8 hours. In the second study cefotetan 2g iv every 12 hours was compared to cefoxitin 2g iv every 6 hours with satisfactory clinical responses in 93 of 95 (98%) cefotetan-treated patients and 41 of 43 (95%) cefoxitin-treated patients. Overall response rates in the two studies were lower in patients with severe peritonitis (82%) or nosocomial infections (70%). Twelve-hourly dosing with cefotetan appears to be as effective and well tolerated in regional peritonitis as treatment with shorter-acting agents.

Topics: Cefotetan; Cefoxitin; Drug Evaluation; Humans; Moxalactam; Peritonitis; 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

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

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

A randomized, double-blind study of cefoxitin (CX) or clindamycin/gentamicin (CG) as adjuncts to the surgical management of peritonitis is reported. Groups with similar infection risks were evaluated by including only patients with abdominal stab wounds, enteric injury, and spillage of the gastrointestinal contents. One hundred ninety-five patients were entered of whom 75 were evaluable. Comparisons of the ages, sex, diagnoses, and measures of outcome were not significantly different. Fifteen per cent (5/34) of CX treated patients had postoperative complications (three infections) vs. 10% (4/41) of patients treated with CG (three infections). Intraperitoneal bacteria were cultured from 62% of CX and 59% of CG patients. Antibiotic resistance, seen in three patients of each group, was not associated with failure. Two moderately sensitive Bacteroides distasonis were each associated with a failure in the CX and CG groups. We deduce that both regimens are effective and that cefoxitin may represent less costly single-agent therapy.

Topics: Adolescent; Adult; Bacteria; Cefoxitin; Clindamycin; Double-Blind Method; Drug Resistance, Microbial; Female; Gentamicins; Humans; Intestinal Perforation; Male; Middle Aged; Peritoneal Cavity; Peritonitis; Premedication; Random Allocation; Wounds, Stab

Topics: Abdomen, Acute; Anti-Bacterial Agents; Cefoxitin; Doxycycline; Exudates and Transudates; Female; Hepatitis; Humans; Laparoscopy; Metronidazole; Oophoritis; Pelvic Inflammatory Disease; Peritonitis; Salpingitis; Young Adult

The aim of the study was to identify risk factors associated with pre-transplant fecal carriage of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae in liver transplant recipients.. Over a 3-year period (January 2009-December 2011), 317 patients who underwent liver transplantation were screened preoperatively for fecal carriage of ESBL-producing Enterobacteriaceae. Risk factors for fecal carriage were investigated by univariate analysis and stepwise logistic regression.. Of the 317 patients screened, 50 (15.7%) harbored an ESBL-producing isolate. Previous infection with an ESBL-producing organism had developed during the last 6 months in 20% of fecal carriers versus in none of the non-carriers. Other variables associated with fecal carriage were a model for end-stage liver disease score ≥25, pre-transplant stay in the intensive care unit ≥48 h, hospital stay ≥10 days in the last 6 months, a history of spontaneous bacterial peritonitis (SBP), exposure to a β-lactam agent in the last month, and prophylaxis with norfloxacin. Independent predictors of fecal carriage in the multivariate logistic regression model were exposure to a β-lactam agent in the month preceding transplantation (odds ratio [OR] = 7.8, confidence interval [CI] = 4-15.5, P < 0.001), and a history of SBP (OR = 2.4, CI = 1.1-4.9, P = 0.02).. Previous infection with an ESBL-producing isolate, recent exposure to a β-lactam agent, and a history of SBP are risk factors for preoperative fecal carriage of ESBL-producing Enterobacteriaceae in liver transplant recipients. Patients at risk of fecal carriage should receive intraoperative prophylaxis and, when necessary, empiric postoperative antimicrobial treatment that includes coverage for these organisms.

Topics: Adult; Amikacin; beta-Lactamases; beta-Lactams; Cefoxitin; Ciprofloxacin; Drug Resistance, Bacterial; End Stage Liver Disease; Enterobacter cloacae; Enterobacteriaceae; Enterobacteriaceae Infections; Escherichia coli; Escherichia coli Infections; Feces; Female; Humans; Imipenem; Klebsiella; Klebsiella Infections; Klebsiella pneumoniae; Liver Transplantation; Logistic Models; Male; Microbial Sensitivity Tests; Middle Aged; Multivariate Analysis; Penicillanic Acid; Peritonitis; Piperacillin; Piperacillin, Tazobactam Drug Combination; Preoperative Period; Risk Factors; Severity of Illness Index

Continuous and twice-daily cefoxitin dosing was used in a highly lethal model of acute peritonitis in mice using intraperitoneal (IP) Klebsiella pneumoniae (Kpn). The purpose was to use antibiotics to create a model of chronic infection. Male Balb/c mice (averaging 20 g body weight) were inoculated IP with 10(3) colony-forming units (CFU) Kpn serotype 2. Controls received subcutaneous saline either twice daily or continuously. Antibiotic groups received 300 mg/kg per day of cefoxitin either twice daily or continuously. Survival and daily weight losses were determined. Another group was inoculated with 10(3) Kpn given twice daily saline or cefoxitin and harvested at 24 hours. Leukocyte counts were performed on peritoneal exudate cells (PEC) and peripheral blood. Cultures determined Kpn counts in blood, lung, and PEC. By 24 hours, saline-treated animals had lost more weight than cefoxitin mice (1 g vs. 2 g, P < 0.05). Continuous cefoxitin showed significant advantage with 50 per cent mortality at 5 days. Kpn levels were not significantly altered by cefoxitin. Cefoxitin treatment extended chronicity by preventing weight loss and increasing survival in a highly lethal, monomicrobial peritonitis model. This model will allow future study of specific host defense mechanisms over a prolonged time period.

Topics: Animals; Anti-Bacterial Agents; Ascitic Fluid; Bacteremia; Cefoxitin; Chronic Disease; Colony Count, Microbial; Disease Models, Animal; Injections, Subcutaneous; Klebsiella Infections; Klebsiella pneumoniae; Leukocyte Count; Lung; Male; Mice; Mice, Inbred BALB C; Neutrophils; Peritonitis; Random Allocation; Serotyping; Survival Rate; Weight Loss

Closed postoperative peritoneal lavage (CPPL) with chlorhexidine gluconate reduces the number of intraperitoneal bacteria and improves the outcome of intra-abdominal infection.. Laboratory animal trial.. Intra-abdominal infection was produced in mice by the cecal ligation and puncture technique. After 16 to 18 hours, the animals underwent relaparotomy and placement of an intra-abdominal catheter for CPPL. In the first experiment animals were randomly divided into 4 groups: no lavage (served as a control), CPPL with chlorhexidine. CPPL with cefoxitin, and CPPL with lactated Ringer solution (LR). Lavage was continued intermittently every 8 hours for 24 hours. All animals received systemic cefoxitin every 8 hours for 7 days. Mortality was recorded every 8 hours for 10 days. In the second experiment, animals were divided into 3 groups: no lavage (served as a control), CPPL with chlorhexidine, and CPPL with LR. Lavage was continued intermittently every 8 hours for 24 hours. The animals were killed 48 hours after reoperation. Bacterial counts from peritoneal fluid and biopsy specimens, as well as peritoneal white blood cell counts, were measured before and after lavage.. Closed postoperative peritoncal lavage with chlorhexidine reduced mortality from 71% in a control group to 37% (P = .003). There was no survival benefit in either the CPPL with cefoxitin (91% mortality) (P = .14) or CPPL with LR groups (90% mortality) (P = .17). The statistically significant findings of analysis of variance evaluation demonstrated a decrease in bacterial counts after cecal excision in all 3 groups. There was a greater reduction in bacterial counts in the chlorhexidine group compared with the control group (P<.05). Bacterial counts decreased in peritoneal fluid, as well as in tissue biopsy specimens, after cecal excision. White blood cell counts significantly decreased after cecal excision in all 3 groups. There was no difference in white blood cell counts between the groups. Correlation analyses demonstrated weak interaction between bacterial and white blood cell counts before or after treatment in all the groups. Pearson r ranged from -0.37 to +0.35, none of which were statistically significant.. In our experiments chlorhexidine lavage resulted in a 50% reduction in mortality and a significant reduction in bacterial counts compared with the control group. There was no survival benefit from lavage with either cefoxitin or LR. There was no reduction in bacterial counts in the LR group relative to the control group. Thus, the survival benefit and the reduction in bacterial numbers are attributed to the antibacterial properties of chlorhexidine rather than to the mechanical washing of the abdominal cavity. Closed postoperative peritoneal lavage with 0.05% chlorhexidine gluconate might be useful in the multimodal treatment of intra-abdominal infection.

Topics: Animals; Anti-Infective Agents, Local; Cefoxitin; Chlorhexidine; Colony Count, Microbial; Leukocyte Count; Male; Mice; Mice, Inbred CBA; Peritoneal Lavage; Peritoneum; Peritonitis

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

To compare the potential therapeutic effect of liposomal vs. free cefoxitin.. Randomized, controlled study, using a rat model of peritonitis.. Government research facility.. Male Sprague-Dawley rats.. Rats were infused intraperitoneally with 6.5 x 10(8) colony forming units of Escherichia coli over 12 hrs. Animals were then randomized to receive intravenous saline, free cefoxitin, liposomal cefoxitin, or plain liposomes twice daily until they were killed.. Free cefoxitin significantly reduced the number of E. coli after 24 hrs compared with saline treatment in both liver and spleen. However, liposomal cefoxitin further decreased the bacterial content by five-fold to ten-fold in these organs. Minimal bactericidal effect was observed in animals injected with plain liposomes. Although administration of liposomal cefoxitin for 7 days further reduced bacterial counts in liver and spleen, there was no apparent beneficial bactericidal effect of free cefoxitin over saline at 7 days. There was approximately a ten-fold reduction in bacterial content in the lungs after 24 hrs in all three treatments, but no further reduction was observed after 7 days. There was no difference in 7-day survival rate in animals treated with plain liposomes or saline (45% vs. 39%). Although survival tended to increase with free cefoxitin treatment (64%), this outcome was significantly improved with the use of liposomal cefoxitin (82%).. Liposomal cefoxitin enhanced bacterial killing in liver and spleen in this model of E. coli peritonitis. It also improved survival outcome relative to no treatment but not compared with free cefoxitin.

Topics: Animals; Body Weight; Cefoxitin; Cephamycins; Disease Models, Animal; Drug Carriers; Escherichia coli Infections; Infusions, Intravenous; Liposomes; Male; Peritonitis; Random Allocation; Rats; Rats, Sprague-Dawley

Topics: Anti-Bacterial Agents; Cefoxitin; Ceftriaxone; Ciprofloxacin; Clindamycin; Contact Tracing; Female; Genital Diseases, Male; Humans; Male; Ofloxacin; Pelvic Inflammatory Disease; Peritonitis; Pregnancy; Pregnancy Complications, Infectious; Sexually Transmitted Diseases

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

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

The systemic tumor necrosis factor (TNF) response has been extensively studied during infection. In addition, antibiotics that cause cell-wall lysis have been associated with endotoxinemia and, therefore, could trigger TNF release. We studied the effects of pretreatment with cefoxitin and/or anti-TNF antibody on mortality and early (90 minutes) and delayed (6 hours) serum TNF levels in a murine model of mixed Escherichia coli/Bacteroides fragilis peritonitis. At low and intermediate inocula levels, cefoxitin, but not anti-TNF antibody, prevented death, and low serum TNF levels were noted in all groups. At the highest inoculum level, mortality was uniform in control, cefoxitin, and anti-TNF antibody groups, and a significant elevation in serum TNF levels was seen only at the 6-hour point in animals receiving cefoxitin. The addition of anti-TNF antibody to cefoxitin at this inoculum level abrogated the 6-hour rise in serum TNF levels and reduced mortality to 40%. These results emphasize that the cytokine response in disease is dependent on both the nature of the insult and other forms of therapeutic interventions.

Topics: Animals; Antibodies, Anti-Idiotypic; Bacteroides fragilis; Bacteroides Infections; Cefoxitin; Disease Models, Animal; Drug Evaluation, Preclinical; Drug Therapy, Combination; Escherichia coli Infections; Immunoglobulin G; Injections, Intramuscular; Injections, Intraperitoneal; Male; Mice; Mice, Inbred BALB C; Peritonitis; Survival Rate; Tumor Necrosis Factor-alpha

The local application of antibiotics to treat intraperitoneal contamination has been used with variable results. Liposomes are not rapidly absorbed from the peritoneal cavity, offering a potential delivery system for intraperitoneal antibiotics. The effects of liposome-incorporated antibiotic administration in a fecal peritonitis model were compared with the effects of conventional intraperitoneal and intramuscular antibiotics. Rats were divided into four groups: untreated, intramuscular cefoxitin, intraperitoneal cefoxitin, and intraperitoneal liposome-incorporated cefoxitin. Quantitative blood cultures were drawn at 4 and 24 hours. Liposome delivery of cefoxitin significantly reduced mortality and bacteremia at 4 and 24 hours compared with control subjects and conventional antibiotic groups. Peritoneal abscess formation tended to decrease in the liposome antibiotic group (mean +/- SEM, 6.86 +/- 0.79) compared with the group receiving free intraperitoneal administration of antibiotics (10.33 +/- 1.63). We conclude that liposomal delivery significantly enhances the effectiveness of cefoxitin in this model of peritonitis.

Topics: Animals; Bacteria; Cefoxitin; Drug Carriers; Injections, Intramuscular; Injections, Intraperitoneal; Leukocyte Count; Liposomes; Peritonitis; Rats; Rats, Inbred Strains; Sepsis; Tobramycin

We examined the effect of muramyl dipeptide (3 micrograms/g body weight) and a broad-spectrum antibiotic cefoxitin (15 mg/kg) on survival and systemic bacteremia in rats with peritonitis. When muramyl dipeptide given 24 hours prior to placement of the bacterial inoculum was combined with a single prophylactic dose of cefoxitin, survival was 100 percent (p less than 0.001) and systemic bacteremia at 4 hours postinoculation was significantly decreased. Twenty-four hour pretreatment with either muramyl dipeptide alone or cefoxitin alone was associated with survival rates of 43 percent and 56 percent, respectively. When muramyl dipeptide was given with cefoxitin at the time of administration of the bacterial inoculum, no survival advantage was seen over the use of cefoxitin alone. There were no significant differences among groups in quantitative bacteremia at 24 hours postinoculation or in the number of intraabdominal abscesses. This study clearly demonstrates an additive effect of muramyl dipeptide pretreatment given with a prophylactic dose of cefoxitin in a human fecal peritonitis rat model.

Topics: Acetylmuramyl-Alanyl-Isoglutamine; Animals; Bacteria; Cefoxitin; Drug Therapy, Combination; Feces; Male; Peritonitis; Rats; Rats, Inbred Strains

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

In an experimental model of peritoneal infection by cephalosporinase- (Ia and Ic) producing bacteria in mice, the reduction of cefoxitin, cefmetazole, and cefazolin concentrations in peritoneal fluid was observed in the mice infected with the Ia enzyme producer, whereas cefbuperazone concentrations were not reduced.

Topics: Animals; Ascitic Fluid; beta-Lactamases; Cefazolin; Cefmetazole; Cefoxitin; Cephalosporinase; Cephalosporins; Cephamycins; Chromatography, High Pressure Liquid; Enterobacter; Enterobacteriaceae Infections; Male; Mice; Mice, Inbred ICR; Peritonitis; Proteus Infections; Proteus vulgaris

Topics: Cefoxitin; Drug Resistance, Microbial; Humans; Peritonitis

Eosinophilic ascites is an uncommon clinical entity with diagnostic considerations separate from those of spontaneous bacterial peritonitis (SBP). We describe a man with documented E. coli SBP with an 80% eosinophilia in peritoneal fluid (total cell count 12,400/mm3) and no peripheral eosinophilia. Antimicrobial therapy resulted in both clinical improvement and resolution of the eosinophilia in the ascitic fluid. The possible role of associated medications and the potential importance of this syndrome are discussed.

Topics: Ascites; Ascitic Fluid; Cefoxitin; Eosinophilia; Escherichia coli Infections; Humans; Male; Middle Aged; Peritonitis; Tobramycin

Patients undergoing splenectomy have increased operative morbidity and mortality, especially when associated with gastrointestinal surgery or injury. This present study was designed to assess the effect of splenectomy on mortality in a polymicrobial fecal peritonitis model and evaluate therapy with antibiotic (cefoxitin) or immunomodulation (glucan). Human stool-barium (0.15 cc) was placed in the peritoneum of Sprague-Dawley rats at the time of splenectomy or sham surgery. Splenectomy animals were then treated with 5% dextrose, cefoxitin (60 mg im q 6 hr), glucan (7.5 mg ip prior to surgery), or cefoxitin plus glucan. Splenectomy resulted in decreased survival (5% vs 30%, P less than 0.05). Treatment with cefoxitin (90%) or glucan (47%) significantly improved survival. Combined glucan-cefoxitin therapy had no improvement over cefoxitin alone. Peritoneal and blood cultures were performed 12 hr postoperatively. There were no significant differences in growth of bacteria between sham and splenectomy animals. Cefoxitin treatment resulted in lower growth of bacteria from both blood and peritoneum (P less than 0.05). Glucan treatment caused a significant decrease in the number of bloodborne bacteria (P less than 0.05). Intravascular colloidal carbon clearance and leucocyte counts were performed at 12 hr postoperatively. Presence of peritonitis significantly enhanced intravascular clearance, while splenectomy had no effect. Addition of glucan or cefoxitin therapy to splenectomy animals did not enhance intravascular clearance. Leucocyte counts were significantly lower (P less than 0.05) when splenectomy was added to peritonitis animals. Glucan and cefoxitin therapy did not increase leucocyte counts. Based on these studies we conclude that (1) splenectomy increases mortality in fecal peritonitis, (2) antibiotic and immunomodulator afford some protection, and (3) exact mechanism of protection remains unclear.

Topics: Adjuvants, Immunologic; Animals; Bacteria; Cefoxitin; Glucans; Leukocyte Count; Male; Peritonitis; Phagocytosis; Rats; Rats, Inbred Strains; Sepsis; Splenectomy

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

Patients who had contaminated traumatic perforations of the gastrointestinal tract and those with acute peritonitis resulting from acute surgical inflammatory conditions were treated with piperacillin or cefoxitin infused intravenously as single therapy for a minimum of five days. Thirty-four patients were given 4.5 grams of piperacillin every six hours and 26 patients, 2.0 grams of cefoxitin every six hours. In the piperacillin group, 63 organisms (34 aerobes and 29 anaerobes) were isolated from pretreatment cultures, while in the cefoxitin group, 73 organisms (35 aerobes and 38 anaerobes) were isolated. Clinical recovery was achieved in 31 of 34 patients receiving piperacillin therapy and in 24 of 26 patients receiving cefoxitin therapy. Organisms were found to be resistant to the respective drug in two piperacillin-treated patients and in one cefoxitin-treated patient, and the patients were given other antibacterial treatment. One patient from each treatment group died of causes unrelated to septic conditions. No serious adverse effects occurred from either antibiotic.

Topics: Abdomen; Abdominal Injuries; Adolescent; Adult; Aged; Cefoxitin; Female; Humans; Infusions, Parenteral; Male; Middle Aged; Peritonitis; Piperacillin; Surgical Wound Infection

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

Some 23 patients suffering from severe gastrointestinal infections were treated with cefoxitin (CFX) at the Bokuto Metropolitan Hospital, surgical ward, from September to November, 1982. Clinical examinations were conducted and the findings bacteriologically evaluated. The following clinical results were obtained: Of 23 patients, 11 were treated for diffuse peritonitis, 5 for localized peritonitis, and 7 for cholangitis. Following treatment, 5 were judged "excellent", 12 "good", 4 "fair", and 2 "poor." The clinical efficacy rate was 74%. Antibiotic disc susceptibility testings for ampicillin, cephalexin, gentamicin, and CFX were conducted. Gram-negative rods, such as E. coli, Klebsiella sp., Proteus sp., and especially, anaerobic B. fragilis, indicated susceptibility to CFX. B. fragilis was resistant to the remaining 3 antibiotics. Transient elevations in S-GOT and S-GPT levels were observed in 2 patients. However, this was not thought to be caused by CFX. No other irregularities were found. CFX is considered to be a drug of first choice for the treatment of severe gastrointestinal infections. However, for infections due to mixed Pseudomonas aeruginosa and other bacteria, concomitant treatment with CFX and an aminoglycoside is recommended.

Topics: Adolescent; Adult; Aged; Bacteria; Cefoxitin; Child; Child, Preschool; Cholangitis; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Male; Middle Aged; Peritonitis

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

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

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

Topics: Adult; Cefoxitin; Clostridium Infections; Female; Humans; Liver Cirrhosis; Peritonitis

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

Twenty one cases of appendiceal peritonitis in children are reviewed. An antibiotic (sodium cefoxitine) has been used during the post-operative course to decrease the risk of suppurative complications. Cultures obtained from peritoneal exudate yielded "E. coli" and "Bacteroides" sp. as the most commonly isolated bacteria. External drainage was placed as a rutine and the percentage of suppurative complications was 14%. No patient showed evidence of adverse reactions to the antibiotic and the mortality of the serie was zero. Obtained results allow to state that cefoxitine is effective in the management of appendiceal peritonitis in children.

Topics: Appendicitis; Ascitic Fluid; Cefoxitin; Child; Drainage; Humans; Peritonitis; Postoperative Complications; Rupture, Spontaneous

Topics: Bacteria; Cefamandole; Cefoxitin; Child; Humans; Peritonitis; Suppuration

Topics: Appendicitis; Cefoxitin; Child; Humans; Peritonitis

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