Oral treatment of peritonitis complicating continuous ambulatory peritoneal dialysis

The efficacy of oral treatment with cephradine in peritonitis associated with continuous ambulatory peritoneal dialysis (CAPD) was compared with that of intraperitoneal cefuroxime over one year. There were 29 episodes of peritonitis in each group and a primary cure was achieved in 66% of the patients treated with cephradine compared with 55% of the patients treated with cefuroxime, suggesting that oral cephradine is as effective as a treatment with intraperitoneal cefuroxime. Nineteen of the 29 episodes in each treatment group were considered suitable for out-patient management and there was no difference in the success rate of either antibiotic regimen. The results suggest that out-patient treatment with oral cephradine is an efficient way of treating CAPD peritonitis.

Peritoneal lavage with metronidazole

It is rational and safe to use metronidazole in peritoneal and wound lavage for the treatment of severe infection. The results of this study compare favorably with that of other studies. In this study, new light has been shed on the treatment of intraperitoneal sepsis, but there is still more work to be done in evaluating the therapeutic value of metronidazole lavage in wounds.

[Study on the transfer of cefroxadine to human tears]

A comparative study to determine the transfer of cefroxadine (CXD), an oral cephem antibiotic, to the human tears was undertaken using cephalexin (CEX) as the control drug. The mean tear levels of 250 mg each of CXD and CEX after oral administration in 6 volunteers were equally peaked at 0.26 micrograms/ml with CXD after 1 to 2 hours and with CEX after 2 hours. The changes of tear levels were also equal for both drugs. The ratios between the tear and the blood levels at 2 hours after oral administration were almost equal with 4.1% for CXD and 3.7% for CEX. From the above evidence it has been confirmed that the both drugs were equivalent with regard to the concentration profiles in human tears after oral medication.

[Clinical evaluation of cefroxadine in bacterial infections of the eye]

Cefroxadine (CXD) capsules and dry syrup, an oral cephem antibiotic, were administered into 120 cases with ocular infections and the following results were obtained: The daily dose of CXD capsule was ranged from 500 to 1,500 mg and that of CXD dry syrup from 17.9 to 85.7 mg/kg, and the duration of CXD administration was from 2 days to 14 days. Clinical response rates classified by diagnosis The clinical response rates were 77.8% (14/18) in blepharitis, 86.7% (26/30) in hordeolum, 62.5% (5/8) in meibomianitis, 74.6% (44/59) in conjunctivitis, 100% (2/2) in corneal infiltration, 100% (1/1) in cellulitis of the lid, in dacryocystitis and in corneal ulcer, respectively. Clinical response classified by isolated organisms The response rates on S. aureus were 80.0% (20/25), on S. epidermidis 75.8% (47/62) and on S. pneumoniae 66.7% (2/3), respectively. The overall clinical response rate on Gram-positive bacteria was 78.3% (94/120). The response rates on H. influenzae, Acinetobacter spp., P. mirabilis, E. coli and Moraxella spp. were ranged from 42.9 to 100%. The sensitivity distributions of clinically isolated S. aureus and S. epidermidis to CXD were ranged from 1.56 to greater than 100 micrograms/ml and from 0.39 to 12.5 micrograms/ml, respectively. The former showed a peak at 3.13 micrograms/ml and the latter in 1.56 micrograms/ml. Side effects in 3 cases (2.3%) out of 129 were observed. That is; glossitis, thirst feeling and palpitation in each case, respectively.

[New oral cephem antibiotic, cefroxadine capsules, against superficial suppurative disease in the field of surgery]

Cefroxadine was administered at dose level of 750 mg/day to 21 cases of superficial suppurative diseases and the following results were obtained: The effective rate determined by the treating doctor was 9/21 (42.9%). The effective rate by the evaluation standard was 12/21 (57.1%). The negative-conversion rate was 11/11 (100%) in the 11 cases in which bacteriological effects were clarified. No side effects were observed in all of the 21 cases.

[Clinical effect and transfer into the wound exudate of cefroxadine used in the treatment of soft tissue infection]

Clinical effect and excretion into wound exudate of a new semisynthetic cephalosporin cefroxadine (CXD), were studied. CXD was given in 25 cases of surgical infections; 6 cases of wound infection, 9 cases of abscess, 9 cases of infected atheroma and 1 case of furuncle. CXD was orally administered in daily dose of 750 to 1,500 mg. Clinical results were excellent in 1 case, good in 18 cases, fair in 3 cases and poor in 3 cases. The overall clinical efficacy rate was 76.0%. Clinical efficacy classified by diagnosis was 66.7% in wound infection, 66.7% in abscess, 88.9% in infected atheroma, and 100% in furuncle. Side effects were not observed in all cases among 25 patients in CXD trials. Studies of excretion into wound exudate of CXD were performed in 1 postoperative case of mamma carcinoma after oral administration of 500 mg of CXD. The concentration of CXD in exudate was 1.12 micrograms/ml in 2 hours, 3.48 micrograms/ml in 3 hours, 4.13 micrograms/ml in 4 hours, 5.56 micrograms/ml in 5 hours and 4.41 micrograms/ml in 6 hours after administration, which was observed that CXD was excreted in wound exudate in high concentration.

[Clinical evaluation of cefroxadine in the field of obstetrics and gynecology]

Cefroxadine (CXD), an oral cephalosporin antibiotic was studied in the field of obstetrics and gynecology and the following results were obtained. CXD was orally given to 22 cases at daily dose of 1,500 mg 3 times a day. CXD administration was given to 22 cases in all; 4 with cervicitis, 6 with endometritis, 2 with puerperal fever, 4 with bartholinitis, 5 with adnexitis and 1 with vulvitis, respectively. Overall efficacy rate was 77.3% (17/22) (excellent 4, good 13, fair 5). As for side effects, a slight diarrhea was observed. CXD was considered to be a useful antibiotic in the field of obstetrics and gynecology by above the results.

[Clinical effect of cefroxadine on surgical infections]

Cefroxadine (CXD), an orally active cephalosporin antibiotic, has a broad spectrum and a bactericidal action. The efficacy of CXD in the surgical field was investigated and the following results were obtained. CXD was administered to 31 cases in all; 13 cases with mastitis, 9 with wound infection, 4 with infected atheroma, 3 with periproctal abscess and 2 with phlegmon, respectively. The daily dose was ranged from 750 mg to 1,500 mg. Clinical effects were good in 27 cases and fair in 4 cases, and the effective rate was 87.1%. As to side effects, a slight diarrhea was observed in 1 case, but the symptom was disappeared after 2 days without a special treatment.

[Clinical evaluation of cefroxadine in the field of obstetrics and gynecology]

Clinical studies of cefroxadine (CXD), a new orally active of cephalosporin, in obstetrical and gynecological field were performed, and the results were summarized as follows. CXD was orally administered to 16 cases of obstetrical and gynecological infections in daily dose 750 approximately 1,500 mg. Clinical efficacy was 88.9% in endometritis (9 cases), 100% in cervicitis (2 cases), 75% in adnexitis (4 cases) and 100% in suppurative haematoma vulva (1 case), respectively. Overall efficacy was 87.5% (14/16). Clinical efficacy classified by caused organisms was 83.3% (10/12) overall, and bacteriological effect was 91.7% (11/12). Neither side effects nor abnormalities in laboratory findings caused by this drug were observed. Based on these results, CXD should be considered a very safe and useful drug for treating obstetrical and gynecological infections.

[Clinical use of cefroxadine in dentistry and oral surgery]

Cefroxadine (CXD) is an orally administered synthesized cephalosporin antibiotic developed by Ciba-Geigy Limited (Switzerland) in 1972. We have studied the clinical effectiveness of this drug in a total of 45 cases of various types of infections in the dentistry and the oral surgery. The studies resulted in showing 18 markedly effective cases, 19 effective cases, 5 slightly effective cases, 1 ineffective case, and 2 unknown cases showing an effective rate of 82.2%. Side effects manifested in 2 cases, of which 1 case was considered to be attributable to CXD, and the occurrence frequency of side effects was as low as 2.2%. In bacteriological test, there were many cases of mixed infections by Gram-positive and Gram-negative bacteria, and these infections were those which are observed in high frequency in dentistry and oral surgery infections. As a result of an overall evaluation of CXD clinical effects, the drug considered to be an antibiotic which is highly useful in dentistry and oral surgery.

[Clinical evaluation of cefroxadine in surgical infections]

Cefroxadine (CXD), a new cephalosporin, was orally administered to 22 cases in total; 5 with wound infection, 4 with felon, 3 with acute pyelonephritis, 2 with furuncle, 2 with infected atheroma, 2 with phlegmone, 2 with abscess, 1 with acute mastitis, and 1 with lymphadenitis. The daily dose was 500 to 1,000 mg, and maximal total dose and duration was 5 g and 5 days, respectively. Therapeutic results were good in 20 cases (effectiveness rate: 91%), fair in 1 and poor in 1. No side effect was observed in all cases among 22 patients with CXD.

Antimicrobial agents for the prevention of urinary tract infection in transurethral surgery

Chemoprophylaxis and disinfection of the operation site for the prevention of bacteriuria after a transurethral operation were assessed in controlled, prospective studies in men with sterile urine preoperatively. The majority of the control patients (65 per cent) suffered postoperative bacteriuria compared to 38.6 per cent after perioperative disinfection with chlorhexidine and 10 per cent or less after each of 2 other regimens (intramuscular cephradine followed by oral nitrofurantoin and chlorhexidine disinfection followed by oral nitrofurantoin). The latter regimen is preferred since it avoids the use of agents with systemic action.

The role of prophylactic antibiotics in appendectomy using delayed primary closure

A prospective randomized trial of prophylactic antibiotics in 202 patients undergoing appendectomy is reported upon. The antibiotics used were metronidazole and cephradine. Half of the patients received antibiotics preoperatively. The other half received antibiotics at operation only upon finding perforation, gangrene or pus formation. All wounds were treated by delayed primary closure. No instance of wound infection, defined as abscess formation or cellulitis, occurred in either group. Antibiotics given prophylactically in every instance appear to have no advantage in preventing wound infection when delayed primary closure is used.

Solution stability of cephradine neutralized with arginine or sodium bicarbonate

The solution stability of two formulations of cephradine--one using L-arginine and the other sodium carbonate as the neutralizer--was studied. Solutions of each formulation of 1% cephradine were prepared in the following diluents: 0.9% sodium chloride injection, lactated Ringer's injection, Ringer's injection, Normosol-R injection, 5% dextrose injection, and sterile water for injection; 5 and 25% solutions were made with sterile water for injection. All solutions were maintained at 25 degrees C, and at least five samples of each were assayed at various time intervals. Assay methods were HPLC, hydroxylamine colorimetric assay, microbiological agar diffusion, and iodometric analysis. By all assay methods, degradation rates of 1% solutions were lower for the arginine-neutralized product than for the one neutralized with sodium carbonate. This may be attributable to the lower pH values of solutions of the formulation with arginine, because one mechanism of degradation is pH-dependent. At concentrations of 5%, the difference in cephradine stability between the two formulations was minimal. At the 25% concentration, the formulations containing sodium carbonate were more stable. At these higher concentrations, the effect of pH is less important because degradation occurs by a combination of mechanisms. The 1% cephradine-arginine formulation was more stable than the same strength cephradine-sodium carbonate formulation in all the i.v. diluents studied. At 5 and 25% cephradine concentrations, the differences in stability between the two formulations were not substantial.

Antibacterial effects of cefroxadine, cephalexin and cephradine in a new in vitro pharmacokinetic model

A pharmacokinetic model has been developed, by means of which all possible time courses of the concentrations of antibiotics in the plasma of treated individuals can be exactly simulated in vitro without diluting the test organism and affecting the growth curves. Equieffective concentrations in the system corresponded to the plasma concentrations in man produced by cefroxadine in a single oral dose of 250 mg and cephalexin and cephradine in a single oral dose of 500 mg.

Low-dose cephradine prophylaxis in obstetric and gynecologic surgery

A short-course, low-dose perioperative prophylactic regimen of cephradine was found to be highly effective in preventing serious postoperative infections (wound, vaginal cuff/pelvic and endometrial) in patients undergoing cesarean sections and vaginal hysterectomies. In patients undergoing abdominal hysterectomy no significant difference was observed in the prevalence of wound and pelvic infections in the antibiotic and placebo-treated groups. In all three operative procedures there was no significant reduction in urinary tract infections. The postoperative length of stay was significantly decreased in cesarean section patients, and a similar trend was observed in vaginal hysterectomy patients. An analysis of risk factors in cesarean section revealed that anemia and labor reduced the effectiveness of prophylaxis. Among vaginal hysterectomy patients those who were anemic and those who were premenopausal were at greater risk of infection. There was a low incidence of adverse drug reactions (less than 0.5%) and no evidence of the promotion of bacterial resistance in cephradine-treated patients.

Pharmacokinetics of cefroxadin (CGP 9000) in man

The pharmacokinetics of cefroxadin have been studied after the administration of single oral and intravenous doses to healthy volunteers. Cefroxadin was assayed by HPLC. The kinetics in plasma following i.v. administration were described by using a three-compartment model. An additional disposition phase was observed following oral administration that could not be detected after the low i.v. dose. The terminal half-life was 1.03 h. The apparent volume of distribution at the steady state was consistent with a diffusion of the antibiotic in all extracellular fluids. The AUC after oral administration was linearly related to the dose. The urinary excretion amounted to 95% of the dose with virtually complete absorption of orally administered drug.

[Clinical evaluation of cefroxadine dry syrup in pediatric field (author's transl)]

Clinical evaluation was carried out on cefroxadine dry syrup (containing 100 mg of cefroxadine per 1 g) for child use, and the following results were obtained. 1. Serum levels: Peak serum levels at 1 hour after single administration of CXD 100 mg (9.1 mg/kg) to a 4-year old child (11kg) and 300 mg (12.8 mg/kg) to a 8-year old child (23.5 kg) were 20.32 microgram/ml and 18.75 microgram/ml, respectively. They declined to 0.78 microgram/ml and 0.88 microgram/ml respectively after 6 hours and to undetectable levels after 8 hours. Half-life was 1 hour and 1.2 hours, respectively. CXD has shown the same concentration pattern as CEX, except for the fact that serum levels were peaked after 30 minutes and not detectable after 6 hours. 2. Clinical responses: CXD was administered, for 7 days, to 33 children with scarlet fever in the dosage of greater than or equal 20 approximately less than 60 mg/kg/day (7 children in greater than or equal to 20 approximately 30 mg/kg/day, 21 in greater than or equal to 30 approximately less than 40 mg/kg/day and 5 in greater than or equal to 40 approximately less than 60 mg/kg/day). Clinical responses were excellent in 19 cases and good in 14 cases, with an efficacy rate of 100%. All strains of group A Streptococcus isolated from the pharynx of 22 children were eradicated within 24 hours. In 1 case each of acute pharyngitis, acute tonsillitis, acute laryngotracheitis and staphylococcal scalded skin syndrome, the dosage of greater than or equal to 30 approximately less than 45 mg/kg/day produced a 100% good clinical response and eliminated the causative pathogens. 3. Side effect: Only 2 cases of eosinophilia were observed in hematologic study as well as in hepatic and renal function tests before and after administration.

[Clinical trials with cefroxadine dry syrup in the treatment of infectious disease of children (author's transl)]

Cefroxadine dry syrup was studied clinically and the following results were obtained. The drug was administered to 19 cases of bacterial infections: acute tonsillitis (6), acute bronchitis (6), scarlet fever (2), acute pyelonephritis (4) and acute cystitis (1). The daily dose was about 30 approximately 50 mg/kg except for 1 patient. The drug was given orally, 3 times a day and the duration of administration was from 4 to 11 days. The overall efficacy rate was 100%, i.e., excellent in 17 cases, good in 2 cases. One patient experienced a mild S-GOT elevation and another patient in mild vomiting. From the results obtained in this study, cefroxadine dry syrup seems to be useful in the treatment of infectious diseases of children.

[Clinical evaluation of cefroxadine dry syrup in children (author's transl)]

Clinical efficacy of cefroxadine dry syrup, a new oral cephalosporin antibiotic, was evaluated in children, and the following results were obtained. 1. Three children were given a single oral dose of about 10 mg/kg of the drug when fasting, and its blood concentrations were determined. Blood concentrations were maximum at 30 approximately 60 minutes, i.e., 16.9 approximately 18.2 microgram/ml, and markedly low at 4 hours. 2. Thirty-six patients with the following diseases were tested with 23.1 approximately 44.4 mg/kg/day of the drug in 3 to 4 divided doses; 21 patients with lacunar tonsillitis, 2 with tonsillitis, 1 with scarlet fever, 4 with bronchitis and tonsillitis, 2 with cystitis, 4 with pyelonephritis, 1 with impetigo and 1 with probable Mycoplasma pneumonia. An overall efficacy rate in 35 patients excluding the last mentioned case was 91.4%, i.e., excellent in 20, good in 12 and poor in 3, and an eradication rate of the causative organisms was 88.9%. 3. Adverse reactions noted were diarrhea in 1 patient, eruption and diarrhea in 1 transient neutropenia in 1, eosinophilia in 3 and an elevation of GOT and GPT in 1. None were significant. 4. Taste and flavor of the drug was considered to be well palatable to children. 5. Taking into consideration of the results of fundamental evaluation of the drug, cefroxadine dry syrup is considered to be a potent new antibiotic in children, and the recommended dose will be 10 mg/kg 3 to 4 times a day.

[Clinical experience with cefroxadine in bacterial infection of children (author's transl)]

In order to evaluate effectiveness of cefroxadine (CXD) in the treatment of bacterial infections of children, the clinical studies were carried out. CXD was orally administered to 30 patients at daily dose of 27.5 approximately 50.0 mg/kg (average 32.3 mg/kg) in 3 approximately 4 divided dose for 3 approximately 10 days (average 4.9 days). The overall efficacy rate in 30 cases was 93.3%, i.e., excellent 22 (73.3%), good in 6 (20.0%), fair in 1 (3.3%) and poor in 1 case (3.3%). Drug eruption and transient eosinophilia were observed in 1 case each out of 30 cases (6.7%), but any other abnormality was not observed throughout this series. Based on the above results, CXD was thus considered to be a useful antibiotic in treatment of pediatric infections.

[Clinical studies with cefroxadine dry syrup in the field of pediatrics (author's transl)]

The clinical and pharmacokinetic studies of cefroxadine (CXD) dry syrup were conducted, and the following results were obtained. 1. A single dose of CXD either 10 mg/kg or 20 mg/kg was given to 2 patients each, and serum levels were peaked in the range of about 10 to 11 microgram/ml. 2. About 30 mg/kg of CXD per day was administered to 47 infants and children (37; upper and lower respiratory tract infection, 3; urinary tract infection, 7; Others) aged from 6 months to 8 years and 1 month weighing 8 to 29 kg, and a 97.8% (44 out of 45) of clinical response was obtained except for 2 cases whose efficacies were uncertain. 3. As the drug-induced side effects, only transient loose stool was observed in 2 cases. This, however, allowed to continue the treatment.

[Use of cefroxadine dry syrup in the management of acute skin infections in children (author's transl)]

1. Cefroxadine dry syrup was in principle administered at the dosage of 10 mg per kilogram of body weight 3 times a day. 2. Evaluation was done in 4 grades, i.e. excellent, good, fair and poor. 3. According to subjective judgement by attending doctors, 'excellent' or 'good' was recorded in 90.7%. 4. If the evaluation was partially standardized, 'excellent' or 'good' was obtained in 74.8% of total 163 cases and in 78.7% of 108 impetigo cases. 5. Side effects were observed in 3 cases (diarrhea 1, fever 2). No direct correlation of these complaints with the administration of the present drug was confirmed.

Cephradine levels in human aqueous humor

In an attempt to investigate penetration of cephradine into the primary aqueous humor in man, we administered 500-mg and 1-g doses of cephradine orally to 27 patients about to undergo elective cataract extraction. A mean peak aqueous humor level of 0.87 microgram/mL was obtained at about three hours after the 500-mg dose. The mean peak aqueous humor level after the 1-g dose also occurred at three hours and was 1.99 microgram/mL, with a range from 0.91 to 3.25 microgram/mL. This concentration was greater than the median minimum inhibitory concentration (MIC) of cephradine for Streptococcus pneumoniae, Str pyogenes, and Staphylococcus aureus (when tested in nutrient agar) but was greater than the MIC for 90% of isolates only with Str pyogenes.

The importance of cephradine in hip surgery

Effective concentrations of antibiotic in the fluid bathing implanted hip prostheses are essential to prevent infection by micro-organisms. Twenty patients undergoing total hip replacement were given one gram of Cephradine intramuscularly one hour before operation and one other received a single bolus of Cephradine intravenously before operation and one other received a single bolus of Cephradine intravenously before operation. The concentrations of antibiotic were greater and persisted longer in the tissue fluid than in the blood. The antibiotic was sufficient to inhibit most micro-organisms causing contamination. We recommend that Cephradine is given intramuscularly one hour before operation and at six-hourly intervals after operation until the drainage tubes and intravenous lines have been removed.

Pharmacokinetics of cephradine given intravenously with and without probenecid

1 In the light of questions raised by an earlier oral study (Welling, Dean, Selen, Kendall & Wise, 1979) the influence of probenecid on the pharmacokinetics of intravenously administered cephradine has been investigated. 2 Intravenous administration of cephradine resulted in a bi-exponential curve and the level of antibiotic after 15 min was significantly greater when subjects received probenecid than when they did not. The influence of probenecid on urinary excretion of cephradine was similar to that observed previously. 3 The increase in serum of cephradine due to probenecid could be accounted for by the decrease in the elimination rate of the antibiotic. These results are discussed in the light of other observations.

Preventing anaerobic infection in surgery of the colon

A randomized prospective study of antibiotic prophylaxis was carried out in patients who underwent elective surgery of the colon. The wound infection rate in 70 patients who received cephradine intravenously in the perioperative period (group 1) was 25%, compared with 8% in 60 patients who received metronidazole and erythromycin base orally before operation (group 2). Both Bacteroides fragilis and Escherichia coli were cultured from the majority of wound infections in group 1, but B. fragilis was not found in any group 2 patients. Wound contamination indicated by wound class or by culture of the subcutaneous tissue of the wound before closure was the best predictor of subsequent wound infections. These results suggest a dominant role for intestinal anaerobes in the genesis of wound infections after colonic surgery and show that antibiotics specifically directed against these organisms can substantially reduce the rate of wound infection.

Prophylactic antibiotics in vascular surgery. Topical, systemic, or both?

A prospective, randomized, blinded study was performed to determine whether prophylactic antibiotics would reduce the incidence of infection in peripheral vascular surgery and whether the route of antibiotic administration was important. Patients undergoing a vascular procedure with a groin incision were allocated to one of four groups with respect to prophylactic antibiotics. Group I received no antibiotic. Group II had topical cephradine instilled in their incisions prior to closure. Group III received a 24-hour perioperative course of intravenous cephradine, and Group IV received both topical and intravenous cephradine. Groin and abdominal incisional infections were significantly reduced (p < 0.01) among patients who received prophylactic antibiotics by either the topical, systemic, or combined routes of administration. No significant differences were noted among the three antibiotic groups. Profundoplasty, femoral embolectomy, and femoral aneurysm repair were each associated with an increased incidence of infection (p < 0.01). Other risk factors were only important in patients not receiving antibiotics. Either intraoperative topical antibiotics or perioperative systemic antibiotics prevent infection in peripheral vascular surgery, but antibiotic administration by both routes is unnecessary.

[Absorption and excretion of cefradine in healthy volunteers (author's transl)]

From experiments in which cefradine (CED) was orally administered to healthy volunteers in doses of 1,000 mg, 500 mg and successive 250 mg after meal and 500 mg in fasting condition, the following results were obtained. 1) Absorption of CED was rapid in fasting volunteers with peak serum levels at about one hour after administration. On the other hand, the absorption was delayed in non-fasting volunteers with peak serum levels at about 2 approximately 3 hours after administration. Absorbed amounts of CED were proportional to the doses with no effect of meal. 2) Maximum urinary excretion of CED was observed in 0 approximately 2 hour-urine of fasting volunteers and 2 approximately 4 hour-urine of non-fasting volunteers. Total urinary recovery of CED was about 85% in either experiment, showing no effect of meal.

Oral antibiotic therapy of skeletal infections in children

Oral and intravenous (IV) antibiotic regimens were compared in 15 children with etiologically defined osteomyelitis and/or septic arthritis. On admission all children were started on standard IV therapy; seven were changed to oral antibiotics within 72 hours and the remaining eight continued on IV therapy for four weeks. Oral antibiotic doses were adjusted to achieve a peak serum bactericidal titer of greater than or equal to 1:8 against the patient's own pathogen. All patients were treated in hospital for four weeks; therapy continued for a minimum of six weeks or until the erythrocyte sedimentation rate (ESR) fell below 20 mm/hr. The clinical course and outcome were similar in both groups. There were no treatment failures nor any relapses during a 12-month follow-up period. This prospective study supports, with controlled data, the concept that acute skeletal infections can be safely and successfully treated with carefully monitored oral therapy.

Pharmacokinetics of a new cephalosporin, CGP 9000 (cefroxadine), in healthy volunteers

Oral doses of 125, 250, and 500 mg of a new cephalosporin, CGP 9000 (7 beta-[D-2-amino-2-(1,4-cyclohexadienyl)-acetamido]-3-methoxy-ceph-3-em-4-carboxylic acid), given to healthy volunteers, were evaluated pharmacokinetically. The mean peak concentrations with the respective doses were 4.5 +/- 1.4, 7.7 +/- 2.7, and 12.3 +/- 4.2 microgram/ml. The maximum serum concentration occurred after 0.5-1.5 h. The amounts recovered unchanged in urine during 12 h were 96.4 +/- 5.1, 92.4 +/- 11.7 and 96.7 +/- 7.6% of the respective doses. There was straight linear kinetics with a doubling of area under the serum curve for each dose, rising from 6.1 with the lowest, through 12.1 with the middle dose to 23.6 microgram.h/ml with the highest dose. There was an apparent lag of 0.3-0.4 h before absorption. Absorption was relatively rapid, with mean absorption rate constants of 4.68-6.26 h-1. Serum half-life varied between 0.9 and 1.0 h with the different doses. The mean renal clearance values with the three doses ranged between 322 and 344 ml/min.

Tissue levels of cephradine in ischaemic limbs following a single intravenous injection

A single dose of 2g cephradine was administered intravenously at the time of anaesthetic induction to 20 patients with occlusive arterial disease. Concentrations of cephradine were measured in serum, subcutaneous fat from the groins of 10 patients underdoing arterial reconstruction and in the subcutaneous fat and skeletal muscle of 10 legs amputated for severe arterial ischaemia. Concentrations of cephradine were adequate for antibacterial prophylaxis at the time of operation in all serum samples, 9 out of 10 samples of subcutaneous fat from reconstruction cases, all muscle and 8 of 10 fat samples from the level of section of amputated limbs, and in 8 of 10 muscle and fat samples from the distal parts of amputated limbs. These results confirm that a single intravenous dose of 2 g cephradine given with anaesthetic provides adequate serum and tissue concentrations for antibacterial prophylaxis during vascular surgery.

Comparison of pivmecillinam and cephradine in bacteriuria in pregnancy and in acute urinary tract infection

48 non-pregnant domiciliary patients referred by general practitioners and 50 pregnant women were treated for bacteriuria with either 500 mg cephradine or 400 mg pivmecillinam every 6 h for 7 days. In the pregnant women, cure rates were over 90% after 2 weeks for both compounds, and after 6 weeks were 86% for cephradine and 78% for pivmecillinam. Cure rates in the non-pregnant were 83% for cephradine and 95% for pivmecillinam at 6 weeks. Seven patients (3 given cephradine, 4 given pivmecillinam) stopped treatment due to side-effects. Overall, side-effects (many of which were trivial) were more common in patients treated with cephradine (51%) than in those receiving pivmecillinam (33%). It is concluded that both drugs are highly effective in these two common types of urinary infection.

Penetration of cephradine and cefazolin into ulcers of patients suffering from peripheral arterial circulatory insufficiency

11 patients with peripheral arterial circulatory insufficiency with ulcers on the big toe or on the heel were given 1 g of cephradine intravenously (i.v.) and later 1 g of cefazolin i.v., two cephalosporins with different degrees of protein binding. Antibiotic concentrations were followed in serum and wound secretions after the injections. The peripheral circulatory state of the patients and the degree of protein binding of the cephalosporins used seemed to be of minor importance for the concentrations of the antibiotics in the ulcers, i.e. the infectious focus, compared to local factors such as the bacterial flora of the ulcers. In-vitro studies with bacterial strains isolated from the ulcers of 2 of the patients indicated that beta-lactamases from gram-negative bacteria might be at least part of the explanation for the low concentrations in wound secretion of one or other of the agents used in 4 out of the 11 patients.

Comparative study of cefaclor and amoxicillin in treatment of urinary tract infection

Cefaclor or amoxicillin was given to 51 randomly assigned patients with urinary tract infections. Inclusion in the study required two pretreatment urine cultures yielding the same organism (susceptible to both antibiotics) in concentrations greater than or equal to 10(5)/ml. Both drugs were administered as 250 mg. orally every eight hours for ten days. Cefaclor was given to 27 patients and amoxicillin to 24. Most patients in both groups had negative urine cultures at five to nine days and four to six weeks following therapy. One patient in each group was unsuccessfully treated. Relapse or reinfection occurred with similar frequency in both treatment groups. Both antibiotics were well tolerated. minimal inhibiting concentrations (MICS) of cefaclor, amoxicillin, cephradine, and cephalexin were determined by an agar dilution technique for the 44 available pretreatment isolates (41 Escherichia coli and 3 Proteus mirabilis). Mean MICs (micrograms./ml., +/- SD) were 2.2 +/- 1.4 for cefaclor, 4.4 +/- 2.0 with amoxicillin, 8.1 +/- 4.2 for cephradine, and 5.7 +/- 3.0 with cephalexin. Cefaclor is highly active in vitro against those gram-negative bacteria which are commonly isolated from urine. Cefaclor is as effective as amoxicillin when administered three times daily for the treatment of urinary tract infection.

Effects of subminimal inhibitory concentrations of antibiotics in experimental infections

The antibacterial effects of subminimal inhibitory concentrations (sub-MICs) of antibiotics were studied in two animal models. In mice, the oral cephalosporin CGP 9000 was effective in 11 of 20 different gram-negative infections and cephalexin was effective in one of these infections, both at 50% effective doses (ED(50)) that produced peak concentrations of drug in plasms equal to one-half to one-sixteenth the minimal inhibitory concentration (MIC) for the infecting organism. In gram-positive infections, both antibiotics were effective only at concentrations above the MIC. In rabbits, sub-MICs of cephaloridine, ampicillin, and gantamicin were maintained for 6-10 hr by intravenous infusion. At steady-state concentrations equal to one half to one-eighth the MIC, the beta-lactam antibiotics caused elongation and filamentation, and gentamicin caused enlargement, of Proteus mirabilis, Escherichia coli, and Salmonella typhimurium in peritoneal exudate; the number of viable cells of each of these bacteria was temporarily reduced. In infections with E. coli and P. mirabilis, sub-MIC's of beta-lactam antibiotics and of gentamicin prolonged the survival rates for infected animals beyond those for control animals. Rabbits infected with S. typhimurium and treated with ampicillin at a concentration of one-third the MIC Tended to die sooner than did control animals.

Wound sepsis following gastrointestinal surgery: a comparison of topical and two-dose systemic cephradine

A prospective study of the effect of the route of administration of prophylactic antibiotic on the wound infection rate following gastrointestinal surgery was performed. Patients were randomly allocated to one of three groups: group 1 received no form of antibiotic prophylaxis; group 2 received 1 g of cephradine applied topically to the wound at closure; group 3 received 1 g of cephradine intravenously at induction of anaesthesia and a further intravenous dose of 500 mg 4 h later. Wound infections occurred in 12 of 83 patients in the control group (14.5 per cent), in 6 of the 83 patients in the group who received topical antibiotic (7.2 per cent) and in 3 of the 82 patients who received systemic antibiotics (3.6 per cent). Only the group who received systemic antibiotic showed a statistically significant reduction in the incidence of wound infections compared with the control group (P = 0.03).

Pharmacokinetics of cephradine suspension infants and children

The pharmacokinetics of cephradine suspension were studied in 16 infants and children who were 13 months to 8 years and 3 months of age (means age, 3.5 years). Mean peak concentrations of 21.3 and 9.9 mug/ml were achieved at 30 min after administration of 60-mg/kg doses to fasting and nonfasting patients. The area under the serum concentration-time curve was 26% larger in fasting than in fed subjects. The half-life of cephradine in serum was 0.8 and 1.0 h in fasting and fed groups, respectively. Antimicrobial activity was detected in 49% of all salivary samples; in 75% of specimens, the concentrations were less than the 50% minimum inhibitory concentration for most pneumococci and group A streptococci. Urinary concentrations of cephradine ranged from 28 to 8,760 mug/ml and were independent of feeding status.

Effect of single and multidose cephradine prophylaxis on infectious morbidity of vaginal hysterectomy

The administration of cephradine prophylactically to patients who were undergoing vaginal hysterectomies resulted in a marked and significant reduction in the incidence of postoperative infections when compared to a placebo group. Cephradine was the cephalosporin studied because of its unique pharmacodynamic properties, which result in high uterine tissue levels. The protective effect was similar whether 1 g was given preoperatively followed by 500 mg IV q. 6 hours for 4 doses, or a single dose of 2 g IV given approximately 1 hour before surgery. Uterine tissue and serum levels of antibiotic were high and correlated with the degree of protection noted.

Intravenous use of cephradine and cefazolin against serious infections

The relative efficacy and safety of cephradine and cefazolin were compared in 180 patients with a variety of serious infections caused by susceptible organisms. The patients were randomly assigned to one of two groups of 90 patients each. Most patients received 2 to 4 g per day, administered by intravenous injection in four equally divided doses, for a minimum of 4 days. Based on the clinical and microbiological results, the two cephalosporins were found to be comparable in therapeutic effectiveness. Toxicity was not a problem with either drug.

Antibacterial efficacy of cefazolin and cephradine in neutropenic mice

The activity of cefazolin (CEZ) and cephradine (CED) was studied in experimentally infected neutropenic mice. Neutropenia was induced by 600 rad whole-body irradiation; an infection was induced by the injection of 5 X 10(6) Escherichia coli into the thigh on Day 5 after irradiation. Antibiotics were administered 1 h later, and antibacterial activity was estimated from bacteria counts made in the homogenized individual thighs 3 h after infection. The effect of a low dose of each of the cephalosporins on the infection was significantly lower in the absence of granulocytes than in animals with intact host defence; at higher dosages the effect of both antibiotics on the infection was the same in neutropenic and unirradiated mice. In the neutropenic mice, CEZ was 2.95 times more active than CED against E. coli in vivo, this difference in activity being similar to that found earlier in normal mice.