Antibiotic prophylaxis for major maxillocraniofacial surgery

A shortened prophylactic regimen of antibiotics for maxillofacial and craniofacial surgery is evaluated. Eighty-five patients were divided into two groups on the basis of the type of incision used. Forty-nine patients undergoing intraoral procedures received penicillin perioperatively and were given one postoperative dose (regimen A). Thirty-six patients undergoing extraoral or combined intraoral and extraoral procedures received penicillin and oxacillin perioperatively, with nine receiving one postoperative dose and 27 receiving an average of seven postoperative doses (regimen B). One infection was observed in the regimen A group, and three were observed in the regimen B group. This infection rate compares favorably to that encountered in the authors' previously reported study on longer prophylactic courses of antibiotics.

Double-blind, placebo-controlled study of oxacillin combined with rifampin in the treatment of staphylococcal infections

A total of 101 patients with proven Staphylococcus aureus infection were included in a double-blind, placebo-controlled study; this study compared oxacillin (12 g/day, intravenously) or vancomycin (2 g/day, intravenously) plus rifampin (1,200 mg/day, orally) with oxacillin or vancomycin plus placebo. We evaluated 65 patients. Of the patients tested, 33 received oxacillin plus rifampin (13 bacteremias), and 32 received oxacillin plus placebo (16 bacteremias). Clinical cure was achieved in 61% of the patients treated with oxacillin plus rifampin and in 56% of the patients treated with oxacillin plus placebo. Improvement was noted in 27 and 25%, respectively, and failure occurred in 9 and 18%, respectively. These differences were not statistically significant. Bacteriological failure occurred in 3 and 28%, respectively (P less than 0.05). None of the failures within the rifampin-treated group was associated with the emergence of a rifampin-resistant mutant. The rates of superinfection were similar in both groups. The geometric means of the serum bactericidal activity after 1, 6, and 11 h were, respectively, 22, 17, and 9 after treatment with oxacillin plus rifampin and 25, 3.4, and 2.3 after treatment with oxacillin plus placebo. It was suggested that the addition of rifampin to oxacillin or vancomycin might only be beneficial to severely ill patients.

[Peritonitis in renal failure patients treated by continuous ambulatory peritoneal dialysis. Treatment by intraperitoneal administration of a group M penicillin]

From February 1980 to February 1983, 55 patients with chronic renal failure were put on continuous ambulatory peritoneal dialysis. Eighty-four episodes of peritonitis occurred., i.e one episode every 9.9 months of treatment. Since staphylococci accounted for 58% of the germs identified, intraperitoneal therapy with a penicillin M was instituted while dialysis was continued through chambers. Cure was obtained in 85.7% of all episodes, either with the penicillin M alone (57% of the cases) or after adjustment of the antibiotic therapy to bacteriological results (28.6% of the cases). Dialysis was discontinued in 10 patients (18%) on account of the peritonitis. The duration of hospital stay for peritonitis was 3.6 days per patient per year. These results were compared with those obtained by other groups. The advantages of penicillin M are its ease of administration, its narrow spectrum and high activity against the pathogens most commonly encountered, and its very low toxicity.

Meningitis due to Staphylococcus aureus

A retrospective analysis of 10 adult patients with community-acquired Staphylococcus aureus meningitis was performed in order to elucidate the characteristics and treatment of this lethal disease. In all patients, a focus of infection outside the central nervous system was apparent at presentation. A poor prognosis was associated with severe underlying disease, greater degree of hyponatremia at presentation, development of seizures, failure of nuchal rigidity to develop, persistent or recurrent bacteremia, and the presence of concurrent S. aureus bronchopneumonia. Degree of deterioration in mental status and cerebrospinal fluid pleocytosis, protein levels, and glucose levels did not appear to have any prognostic significance. Therapy with rifampin and a semisynthetic penicillin effected a cure in all six patients treated with this regimen. In contrast, three of four patients treated with other antibiotic combinations died. On the basis of this experience, it is concluded that further trials with rifampin in combination with another anti-staphylococcal antibiotic for the treatment of S. aureus meningitis are warranted.

[Advantages and hazards of preventing infection following cesarean section--clinical and bacteriologic results of a high-dosage treatment with mezlocillin and oxacillin short-term preventive following clamping of the umbilical cord]

Between August 1980 and August 1981 a prospective randomised study was conducted at the Krankenhaus Nordwest , Dept. of OBGYN , Frankfurt, to investigate the efficacy of a short term prophylaxis using mezlocillin and oxacillin ( Optocillin ) in reducing infections after Caesarean section (6 gs Optocillin after clamping the umbilical cord and after 8 and 16 hours, respectively). Both the study group (sg) and the control group (cg) consisted of 50 patients each. Both groups were statistically homogeneous . Infections were significantly reduced by the prophylaxis: sg 26%/cg 64% - p less than 0,001, febrile morbidity: sg 10%/cg 38% - p less than 0,001, endometritis: sg 6%/cg 20% - p less than 0,08, UTI: sg 18%/cg 36% - p less than 0,05, wound infections: sg 2%/cg 18% - p less than 0,02. Severe infections, however, were seen in neither group. The duration of infections was shorter in the sg. The various postoperative infections were associated with different risk factors (rf) - endometritis: green amniotic fluid, operating time greater than 75 min; cervical dilatation less than 2 cm, UTI: PROM (greater than 6 hs), operating time less than 75 min, internal monitoring, cervical dilatation greater than 2 cm, wound infections: green amniotic fluid, internal monitoring, frequent vaginal examinations (greater than 6), cervical dilatation greater than 2 cm and operating time greater than 75 min. The prophylaxis was especially effective in the presence of the following rfs: green amniotic fluid, internal monitoring, frequent vaginal examinations (6), operating time greater than 75 min and when associated with combined rfs. The reduction of wound infections following the prophylaxis can be ascribed to the elimination of organisms (Staph. spec., enterococci,) at the site of operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Apparent oral contraceptive failure associated with antibiotic administration

The concomitant use of antibiotics and oral contraceptives should be included in the assessment of contraceptive failure. A case of unwanted adolescent pregnancy during the use of a semisynthetic penicillin and an oral contraceptive is presented and discussed. Advising a different contraceptive method or an additional contraceptive modality may be indicated in adolescents taking long-term antibiotic medication.

Antibiotic and clavulanic acid treatment of subcutaneous abscesses caused by Bacteroides fragilis alone or in combination with aerobic bacteria

A subcutaneous abscess model was utilized in investigating the usefulness of various antimicrobial combinations in the treatment of mixed aerobic-anaerobic infections in mice. The infected animals were treated for seven days with single or combined antimicrobial therapy. The single agents used were penicillin, clavulanic acid, oxacillin, metronidazole, and gentamicin. The antimicrobial combinations used were penicillin plus clavulanic acid and metronidazole plus penicillin, oxacillin, or gentamicin. Administration of a single agent was effective in treating abscesses caused by a single susceptible organism. The only effective therapies for mixed infections were the combinations of penicillin plus clavulanic acid or metronidazole plus gentamicin. This study demonstrated the efficacy of penicillin and clavulanic acid in the treatment of infections caused by Bacteroides fragilis alone or in combination with beta-lactamase-producing aerobic bacteria.

[Penetration of mezlocillin and oxacillin into the glandular and adipose tissue of the breast after simultaneous intravenous infusion. A pharmacokinetic study]

The concentrations of mezlocillin and oxacillin were measured after simultaneous intravenous infusion of 4 and 2 g respectively in serum, fat and mammary gland tissue of 35 patients. The maximum mean concentrations of mezlocillin were measured in serum with 281 micrograms/ml and in fat with 38 micrograms/g after the end of the infusion and in the mammary gland with 52.3 micrograms/g after 90 minutes. Mezlocillin concentrations of less than or equal to 2.0 micrograms/ml and g respectively were found after 6-8 hours after the end of the infusion. The maximum mean concentrations of oxacillin were measured in the serum with 107.8 micrograms/ml also after the end of the infusion, declining to levels less than or equal to 2.0 micrograms/ml within 6 hours. Measurable oxacillin-concentrations could not be found in the fat and in the tissue of mammary gland with the chosen dose. The clinical relevance of the results is discussed.

Ocular penetration of subconjunctival oxacillin, methicillin, and cefazolin in rabbits with staphylococcal endophthalmitis

The concentrations of oxacillin, methicillin, and cefazolin were examined in the infected eyes of pigmented rabbits with Staphylococcus aureus endophthalmitis after a subconjunctival dose of 100 mg. The three drugs had fairly similar ocular pharmacokinetics. The tissue concentration usually peaked within 30 min. Levels in the aqueous humor rose more slowly; the respective maximal concentrations of methicillin, oxacillin, and cefazolin were 72, 1,180, and 111 micrograms/ml. Oxacillin also produced the highest levels in the cornea. Penetration of the vitreous humor was poor with all three drugs, apparently owing to a diffusional barrier in the choroid-retina tissue complex. The respective median vitreous levels of methicillin, oxacillin, and cefazolin were 0.7, 0.6, and less than 0.8 micrograms/ml. These values are close to the concentrations usually required to inhibit S. aureus in vitro. Our results suggest that subconjunctival oxacillin achieves higher concentrations in anterior ocular tissues than do the other two drugs, but more aggressive approaches are necessary in treating endophthalmitis.

[Antibiotic concentrations in wound secretions and bone during the simultaneous administration of mezlocillin and oxacillin]

Mezlocillin and oxacillin have been used in combination for short-term antibiotic prophylaxis in orthopedic surgery. Antibiotic concentrations were measured in serum, wound secretions from subcutaneous tubings and bone. Half an hour after the i. v. application of 4 g mezlocillin + 2 g oxacillin, the concentrations in wound secretions were 20% of the serum levels. After four hours the levels of both antibiotics in wound secretions increased to 2.66 times the serum levels of mezlocillin, and 5.37 times those of oxacillin. After eight hours the concentrations in wound secretions dropped to about one half, but remained well within therapeutic levels. The parallel course of the concentrations of both antibiotics in wound secretions indicates that mezlocillin and oxacillin have very similar half-lives in wound secretions, although the serum half-lives (t 50% beta) of the two antibiotics are different. The concentrations obtained from cancellous bone were approximately. 10% of the serum levels one to two hours after the antibiotic infusion.

Desensitization of patients allergic to penicillin using orally administered beta-lactam antibiotics

When patients allergic to penicillin develop life-endangering infections that require treatment with beta-lactam antibiotics, they face a fatal infection or the possibility of a fatal allergic reaction. We have approached this situation by using an oral desensitization procedure before full-dose antibiotic therapy. Thirty consecutive patients with histories of allergic reactions to penicillin, positive immediate wheal and flare skin-test reactions to penicillin determinants, and life-threatening infections were studied. Bacterial endocarditis requiring penicillin G therapy led to desensitization of 19 patients, Pseudomonas sepsis of pneumonia requiring treatment led to desensitization of nine subjects, and staphylococcal infections requiring therapy with a penicillinase-resistant penicillin led to desensitization of two patients. Penicillin G or carbenicillin were administered orally, beginning with 100 U or 60 microgram, respectively. At 15-min intervals, progressively doubled doses were given during continuous monitoring for the appearance of allergic reactions. Within 5 hr, full therapeutic doses were administered intravenously. Skin-test reactions disappeared or diminished in all 23 subjects who were retested after desensitization. Full courses of antibiotic therapy and cure of the infections were accomplished in 30 of 30 patients. No deaths, anaphylaxis, or severe acute allergic reactions occurred. Pruritic cutaneous eruptions appeared in nine patients (30%) 6 to 48 hr after the onset of therapy. One patient developed reversible nephritis 3 wk into therapy with penicillin G. The results of this study suggest that oral desensitization is an effective, relatively safe approach to administering beta-lactam antibiotics to penicillin-allergic patients with life-threatening infections.

Sodium oxacillin in the horse: serum, synovial fluid, peritoneal fluid, and urine concentrations after single-dose intramuscular administration

Six healthy adult mares were given a single dose (25 mg/kg of body weight) of sodium oxacillin IM. Oxacillin concentrations in serum, synovial fluid, peritoneal fluid, and urine were measured serially over a 48-hour period. The mean peak serum oxacillin concentration was 9.75 microgram/ml at 0.5 hour after injection. Mean peak oxacillin concentrations in synovial and peritoneal fluids were 1.45 microgram/ml and 2.60 microgram/ml at 1 hour and 2 hours, respectively. These concentrations decreased in parallel with serum values and were not measurable at 48 hours. Urine concentrations of oxacillin were high, with a mean peak concentration of 2,790.2 microgram/ml at 0.5 hour.

[Studies reagarding the bioavailability of oxacillin from preconditioned powders]

Previous studies have pointed out a good antimicrobial activity of two oxacillin salts--DBED--oxacillin and calcic oxacillin--which were conditioned as "preconditioned powders" for oral suspensions. The above mentioned preparations were followed up by administration to animals, and similar seric concentrations in DBED oxacillin and sodic oxacillin (with the difference that insoluble salts present a long-time activity) were pointed out.

[External ventricular drainage: a possible method of treating cerebrospinal shunt infections and ventriculitis (author's transl)]

Infectious complications of hydrocephalus shunts are serious problems. A possible method of treating such infections is by external ventricular drainage (EVD). 20 patients - 17 with infected shunts, 3 with neonatal meningitis, ventriculitis and subsequent hydrocephalus - were treated by EVD and the results are presented in this report. The advantages of the procedure are control of the intraventricular pressure to bring it within normal limits and the possibility of intraventricular antibiotic instillation to supplement systemic therapy. Furthermore, the optimal operation time for the definitive shunt can be assessed by EVD once the infection has been overcome.

[Effect of administration of ampiox and guanosine triphosphate on the concentration of cyclic nucleotides in the muscle tissue of a zone of inflammation]

Experiments on rabbits with infiltrates induced by intracutaneous injection of staphylococcal culture were made to examine the content of cyclic nucleotides in the adjacent muscle tissue under the effect of administering ampiox alone or combined with guanosine triphosphate (GTP). Combined injection of ampiox and GTP to the infected animals produced a considerable elevation in the content of cAMP (more than 2 1/2-fold) and in the cAMP/cGMP ratio along with a beneficial therapeutic effect. The possible mechanisms of action of the agents administered are discussed.

Septic arthritis in a Charcot joint

Two patients with Charcot joints developed septic arthritis. The infection in the first patient was treated successfully by repeated needle aspirations and parenteral oxacillin administration. In the second patient closed drainage and parenteral penicillin were not successful in eradicating the infection, and surgical incision with suction drainage was required. Technical difficulties achieving arthrodesis in a Charcot joint suggest that repeated needle aspirations are the preferred method of initial joint drainage. Surgical drainage is advised for loculated, grossly purulent parts of the joint.

Toxicity of antibiotic combinations for vitrectomy infusion fluid

We have found that gentamicin 8 microgram/ml in various combinations with methicillin 25 microgram/ml, oxacillin 10 microgram/ml, clindamycin 10 microgram/ml and penicillin 80 microgram/ml to be nontoxic to the retina when used in vitreous replacement fluid.

Single or combination therapy of staphylococcal endocarditis in intravenous drug abusers

Staphylococcus aureus is the commonest cause of acute endocarditis in intravenous drug abusers. In-vitro and in-vivo animal studies have found increased killing of organisms with the combination of a beta-lactam antibiotic and an aminoglycoside. These findings have created a controversy about the use of such combination therapy. We randomly treated 25 episodes of S. aureus endocarditis in intravenous drug abusers with either single or combination antibiotic regimens. Mean days to defervescence were similar in both groups: 6.3 d (SEM, 1.49 d) for the single drug group and 6.6 d (SEM, 1.02 d) for the group treated in combination with an aminoglycoside. There were no bacteriologic failures or relapses in either group. No patients needed valvular surgery, and the mortality rate was zero. Thus, it appears that single drug therapy with an appropriate beta-lactam antibiotic is adequate and appropriate in intravenous drug abusers with S. aureus endocarditis.

[Trial study of ampiox sodium used intravenously in the clinical picture of internal diseases]

Clinical efficiency of intravenous ampiox was shown. The drug was used mainly in the treatment of patients with bronchopulmonary diseases and other infections. The results of the treatment proved to be good and satisfactory in 12 out of 15 patients. In 3 severe patients the antibiotic therapy produced a temporary effect. The side effects were of allergic genesis and rapidly disappeared after discontinuation of the treatment and administration of tavegi or dimedrol. No phlebitis cases were observed.

[Clinical study of oxacillin for intravenous administration in heart surgery after operations with artificial circulation]

Intravenous sodium oxacillin of Soviet production was subjected to clinical trials in 50 cardiosurgical patients. The patients were operated under conditions of artificial circulation. The antibiotic was used for prophylaxis and therapy of the postoperative pyo-inflammatory complications. In the group of the patients observed no lethal cases due to the post-operative infection were registered.

Hepatitis from intravenous high-dose oxacillin therapy: findings in an adult inpatient population

A retrospective review of all patients who received oxacillin intravenously in doses greater than 6 g/day was done. Eight patients in whom oxacillin-associated hepatitis developed were found and compared with a control group of 46 patients who had received high-dose oxacillin and in whom oxacillin-associated hepatitis did not develop. The latent period to development of typical symptoms of hepatitis varied from 2 to 21 days. Laboratory abnormalities were compatible with anicteric hepatitis and reverted to normal after withdrawal of the drug. Oxacillin hepatitis most like represents a hypersensitivity reaction. We recommend that routine liver chemistries be done regularly in all patients receiving high-dose intravenous oxacillin.

Oxacillin induced neutropenia. A case report

Oxacillin-induced neutropenia is reported in a 16-year-old boy being treated for osteomyelitis. The startling neutropenia developed after 20 days of 200 mg/kg/day of intravenous oxacillin. The neutropenia was not associated with symptoms and was rapidly reversible upon stopping the antibiotic. This reaction may happen with any of the betal lactam antibiotics and is believed to be a direct toxic effect on white cell precursors in the bone marrow.

[Clinical evaluation of intravenous administration of ampicillin-oxacillin (Broadcillin 'Banyu') in bacterial infections in children (author's transl)]

Broadcillin 'Banyu', which contains an equal amount of ampicillin and oxacillin was given intravenously to children with acute bacterial infections and the following results were obtained. 1. Patients were 55 children with the following bacterial infections; respiratory tract infections (8 cases), pneumonia (34), sepsis (1), meningitis (1), cutaneous and subcutaneous suppurative inflammation (5), osteomyelitis (1), urinary tract infection (2), enteritis (1), and chemoprophylaxis (2). They ranged in age from newborns to 8 year old, but most of them were infants. In the majority of the patients, broadcillin 'Banyu' was administered 50 approximately 150 mg/day in three to four equally divided doses by one shot-injection or by a continuous drip infusion for a period of 2 approximately 10 days. The overall efficacy rate was 88.7% in 53 cases after two cases of chemoprophylaxis were excluded, i.e., excellent in 28, good in 19 and failure in 6: excellent in 4 and good in 4 in 8 cases of respiratory tract infections; excellent in 20, good in 11 and failure in 3 in 34 cases of pneumonia (an efficacy rate 91.2%); failure in sepsis and meningitis: excellent in 2 and good in 3 in 5 cases of cutaneous and subcutaneous suppurative inflammation; excellent in osteomyelitis; excellent in 1 and good in 1 of 2 cases of urinary tract infection; failure in enteritis. 2. Adverse reactions were noted on 10 occasions in 9 cases (16.4%), including 1 case of skin eruption, 1 case of eosinophilia, 5 cases of slight elevation of GOT, 1 case of slight elevation of GPT and 2 cases of slight elevation of BUN. 3. Based on the above results, it was concluded that clinical effect of broadcillin 'Banyu' by an intravenous administration is comparable to its intramuscular route and that safety of intravenous usage seems to be verified as long as the above described dosage is followed.

Comparison of methicillin, nafcillin, and oxacillin in therapy of Staphylococcus aureus endocarditis in rabbits

Methicillin (M), nafcillin (N), and oxacillin (OX) (400 mg administered intramuscularly every 8 hours) were compared in the therapy of left-sided endocarditis in rabbits infected with two different strains of Staphylococcus aureus. The three antibiotics were equally effective in eliminating staphylococci from cardiac vegetations. N and OX were four to eight times as active against the staphylococci as M in broth but had equivalent activity in serum. The peak M and OX levels in serum were at least twice the peak N level, but the half-life of N in the serum (2.1 hours) was about three times that of M (0.6 hours) and twice that of OX (1.1 hours). Serum bactericidal activity tests demonstrated essentially equal activity with the three antibiotics 1 and 2 hours after injection; however, at 4 and 6 hours N had an advantage over M and OX. Therefore, despite clear differences in vitro activity, protein binding, and pharmacodynamics, M, N, and OX were equally effective in therapy of staphylcoccal endocarditis in rabbits.

Leukopenia and granulocytopenia after oxacillin therapy

Two cases of granulocytopenia and leukopenia developing after high-dosage oxacillin therapy given intravenously are described. One patient developed leukopenia and granulocytopenia after 17 days of therapy. The conditions were reversible when oxacillin therapy was discontinued. In the other case, the adverse reaction developed within 48 hours after therapy began and the patient died from heart failure. Leukopenia and granulocytopenia as adverse effects of oxacillin therapy should be kept in mind, especially when high dosages are used.

Use of systemic antibiotics for prophylaxis in surgery: a critical review

We reviewed the English-language literature over a 16-year period (1960 through 1976) on the subject of prophylaxis with systemic antibiotics in surgery. Trials in genitourinary and cardiovascular surgery were not reviewed. Our definition of prophylaxis is antibiotic administration of the absence of infection or contamination. Of 131 articles reporting clinical trials using systemic antibiotics for prophylaxis, only 24 met the criterion on an appropriately designed study that generated evaluable data. In these, systemic antibiotics were shown to be of value in reducing wound infections after abdominal and vaginal hysterectomy, cesarean section, biliary surgery, total hip replacement, and microneurosurgical craniotomy. Antibiotic prophylaxis was of no value in laparotomy and groin hernia repair. Patients undergoing any of 21 different operations did not benefit from prophylactic antibiotic administration, though study groups were too small or infection rates too low to allow for firm conclusions. In certain patients at high risk of infection, systemic prophylaxis is warranted. Future clinical studies must be designed as randomized, blinded, prospective trials, with antibiotics administered by a parenteral route beginning preoperatively.

Subtherapeutic dicloxacillin levels in a neonate: possible mechanisms

A neonate treated initially with oxacillin intravenously for two weeks and who was receiving phenobarbital for a seizure disorder subsequently failed to achieve therapeutic levels of orally administered dicloxacillin, even when the dosage was as high as 175 mg/kg/day. Intestinal absorption was documented by high serum peak levels. The low trough levels correlated with a high urinary excretion rate. The possibillity that renal tubular transport of dichloxacillin was stimulated by administration of penicillin derivatives (and/or phenobarbital) is suggested, and the need for careful monitoring of serum levels of antibiotics in neonates is emphasized.

[Lysozyme activity in the leukocytes and blood serum of white rats administered massive doses of penicillin preparations]

Activity of lysozyme in the blood serum and leucocytes was determined. The experiments were carried out on albino unbred rats weighing 170 to 200 gm. Benzylpenicillin and oxacillin were administered intramuscularly in doses of 500000 Units/kg or 20000 gamma/kg once every 24 hours for 2, 4 and 6 days. The activity of lysozyme was determined by the turbidimetric and agar-diffusion methods. It was found that the activity of lysozyme in the leucocytes increased by the 5th day accompanied by a simultaneous decrease in its level in the serum followed by reaching the initial values. The data are indicative of the fact that the use of antibiotics in mega-doses is not contraindicated from the point of view of their effect on lysozyme activity.

Stability of sodium oxacillin in intravenous solutions

The influence of concentration, vehicle, dextrose and temperature on the stability of sodium oxacillin solutions was determined using a chemical kinetic approach. Sodium oxacillin degraded faster in dextrose solution than in sodium chloride injection. This finding was attributed to the catalytic effect of dextrose on sodium oxacillin hydrolysis. Solutions of 1-50 mg/ml oxacillin in each vehicle were found to be stable for 24 hours at 23 C. The degradation of sodium oxacillin in various dextrose solutions was independent of oxacillin concentration, and followed first order kinetics.