cefoxitin and Skin-Diseases--Infectious

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

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

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

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

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

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

A unique case is presented in which disseminated Mycobacterium chelonae ssp. abscessus was found in a normal immunocompetent host after a traumatic injury. Although disseminated disease is known to occur in immunocompromised and postsurgical patients, this case is unusual in that it occurred in a patient with no evidence of immunodeficiency and with a known portal of entry.

Topics: Adult; Amikacin; Cefoxitin; Drug Therapy, Combination; Female; Humans; Immunocompetence; Mycobacterium Infections; Skin; Skin Diseases, Infectious; Wounds, Penetrating

Disseminated disease due to rapidly growing mycobacteria is manifested by positive blood cultures and multiple skin and subcutaneous abscesses. A patient had T-cell lymphoma and disseminated disease; he also had neutropenia intermittently. Single-agent therapy with amikacin sulfate or cefoxitin sodium was not adequate during periods of neutropenia, and combination therapy was necessary to control the infection. Clinical response correlated with detectable serum inhibitory levels of the antimicrobial agents. Surprisingly, the organism was not killed by either amikacin or cefoxitin, a finding that correlated with the absence of serum bactericidal levels. This case suggests that granulocytes may play a role in the host's response to this organism, and determination of serum inhibitory and possible bactericidal levels may be useful in monitoring therapy.

Topics: Adult; Amikacin; Cefoxitin; Drug Resistance, Microbial; Granulocytes; Humans; Kanamycin; Lymphoma; Male; Mycobacterium; Mycobacterium Infections; Mycobacterium Infections, Nontuberculous; Neutropenia; Nontuberculous Mycobacteria; Skin Diseases, Infectious

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

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