Materno-fetal cephradine transfer in pregnancy

Cephradine, a semisynthetic cephalosporin, has widespread use. There is, however, a paucity of data on the transfer of this antibiotic in pregnancy. Studies were undertaken after an intravenous dose of 2 g of cephradine was given in two elective situations: (i) therapeutic abortion in the first trimester and (ii) elective cesarean section in late pregnancy. Blood and tissue levels of cephradine obtained showed that the antibiotic is rapidly transferred to the feto-placental unit throughout pregnancy after intravenous administration to the mother.

Pharmacokinetics of oral cephalosporins: cephradine cephalexin

A crossover experiment was utilized to compare the pharmacokinetics of a 1-g dose of cephalexin tablets, cephalexin capsules, or cephradine capsules in nine normal human volunteers. These antibiotics were administered as three formulations: two 500-mg capsulin every 6 hr for five doses, and one 1000-mg tablet of cephalexin every 6 hr for five doses. Pharmacokinetic parameters in the experimental groups showed no statistical differences (p greater than 0.1), indicating that these drugs are equivalent pharmacokinetically.

"Discontinuous" antibiotic therapy for urinary tract infections

Although it is a common belief that most antibiotics require 4 doses daily, on theoretical grounds such frequent administration may not be necessary (at least for bactericidal antibiotics) and can compromise patient compliance. In 548 patients with urinary tract infections studied under double-blind conditions, 1 g of cephradine orally twice daily provided results equivalent to those obtained with 500 mg of cephradine given 4 times a day. A total of 242 (89%) of 272 patients in the b.i.d. group and 246 (89%) of 276 patients in the q.i.d. group responded well and rapidly. The incidence of adverse reactions attributable to cephradine was equivalent in the two groups.

[Cephradine in open heart serugery. Concentrations of cephradine in pericardial exudate and serum after cardiac surgery (author's transl)]

The diffusion of cephradine into the pericardial exudate was measured in 19 patients undergoing heart surgery. Every patient received 2 grams of cephradine (=30 mg/kg) during a 20 minute infusion period, before, during, and after the operation, and than at intervals of 6 hours, together 8 grams per day. The highest mean serum level, 10 minutes after the end of the first injection was 150 microgram/ml and after repeated dosages 102.5 microgram/ml, and at the end of the infusion interval 3.2 microgram/ml in the mean. At the time of opening the pericardium the concentration of the substance in the pericardial exudate, 15, 30, 45 and 60 minutes after finishing the first injection, varied from 4.1 to 38.6 microgram/ml in the average. The postoperative maximum levels were higher than 50 microgram/ml and 6 hours after the respective administrations the levels varied between 12.83 and 15.77 microgram/ml in each case. These high concentrations of cephradine in the pericardial exudate could not be attributed to seepage of blood into the pericardium.-At specific "check points" bacteriological materials were taken. Out of 1168 specimens only 6.7% were bacteriological positive. Drains in wounds, the pleura or the pericardium were sterile in most cases. Intravenous catheters were contaminated only in 1%. However the contamination rate rises with period of storage. The results show that cephradine exhibits good diffusion into the exudate of pericardium. With the chosen dosage the concentrations of the antibiotic in the pericardial exudate are higher than the MIC values of most pathogen bacteria.

Cephradine penetration into cerebrospinal fluid and effects of its administration into the cerebral ventricles of cats

In cats that had high, sustained serum concentrations of cephradine, penetration of the drug into the cerebrospinal fluid (CSF) was poor. Serum cephradine levels were, on the average, 100-fold higher than the CSF levels. On the other hand, the direct injection of cephradine into the lateral cerebral ventricles of cats yielded high CSF cephradine concentrations without evidence of central nervous system toxicity.

[Clinical studies on cephradine (CED) (author's transl)]

Cephradine (CED) was administered intravenously to the patients with respiratory infection or urinary tract infection with the dosage of 1.0 approximately 4.0 g daily and their clinical effects were investigated. Good clinical effects of CED were obtained in 5 of 8 cases with respiratory infections and in 2 of 5 cases with urinary tract infections. Side effects were noted in 2 cases, but they improved rapidly by the cessation of the drug administration. One case developed skin eruption and the other case complained general burning, palpitation after intravenous injection and slight insomnia. CED is seemed to be effective antibiotic for the respiratory as well as urinary tract infections clinically. However it was advisable that careful attention should be paid when CED is administered to the patient having drug allergy or nephropathy.

[Administration of cephradine to dermatoses by injection (author's transl)]

Ten cases of various kinds of dermatoses underwent cephradine by injection. Two cases injected cephradine intramuscularly resulted in severe pain. Three of 4 cases with pyogenic skin infection revealed excellent results. Three cases were prevented from secondary infection. Adverse effects such as vertigo were avoided by lowering the speed of intravenous injection. No abnormal findings of serum GOT and GPT levels after the completion of the treatment was noted in 7 of 8 cases, but one case which was administrated large dosis of corticosteroid concomitantly revealed elevated level in this finding.

[Ophthalmic application of intravenous cephradine (author's transl)]

Basic and clinical experiments were performed on intravenous cephradine (CED) in ophthalmological field. The results are summarized as follows. 1. Serum concentration: After intravenous injection of 1.0 g CED, in a single dose, to a healthy adult, the peak of serum level (34.0 mug/ml) was attained at 15 minutes, then decreased quickly to 2.3 mug/ml by 6 hours. 2. Ocular penetration in rabbit eye: (1) Aqueous humor concentrations: The peak level of aqueous humor (13.45 mug/ml) was obtained at 30 minutes after intravenous injection of 50 mg/kg, in a single dose. Aqueous/Serum ratio was 38.07%. After instillation of 5 mg/ml solution of CED, 5 times every 5 minutes, the aqueous level was recognized 30 minutes and 1 hour, and no detectable 4 hours. After 50 mg/0.5 ml CED subconjunctival injection, in a single dose, the high aqueous levels were observed at 30 minutes and 1 hour, and still detectable 4 hours later. (2) Ocular tissue concentrations: The ocular tissue concentrations at 30 minutes after intravenous injection of 50 mg/kg CED were high in both outer and inner parts of the eye. After 4 hours, the tissue levels remained relatively high concentrations. (3) CLINICAL RESULTS: Intravenous administration of 0.5, 1.0 or 2.0 g CED 1 or 2 times daily revealed excellent or good effects in 8 of 12 cases, such as external hordeolum, internal hordeolum, lid abscess, chronic dacryocystitis, orbital abscess and corneal ulcer. (4) Side effects: Three cases out of 12 complained burning sensation by intravenous injection of CED, but in neither case was it found necessary to withdraw the drugs. No severe side effects such as allergic reactions were observed. No abnormal findings in hepatic and renal function tests were observed.

[Studies on cephradine for intravenous injection (author's transl)]

1) The half-life of serum concentration of cephradine (CED) in patients with normal renal function, was 30 minutes and it prolonged to 83 minutes when combined with probenecid. 2) In the patients with severely impaired renal function, mean serum concentration of CED was 33 mcg/ml 24 hours after 1 g intravenous injection. 3) In clinical observations of 17 cases with infections of lung, urinary tract, and bile duct, the treatment with CED showed excellent results in 5 cases, good in 6, undetermined in 1. No remarkable side effect was observed.

[Application of parenteral cephradine in urinary tract infections (author's transl)]

A new antibiotic cephradine was administered intravenously for 3 approximately 7 days at daily doses of 1.0 approximately 2.0 g to 56 patients, including 39 cases of acute urinary tract infections, 13 of chronic urinary tract infections and 4 for postoperative prophylaxis. Of 39 cases with acute urinary infections, definite response was seen in 35 cases and no definite response in 4 cases. Of 13 cases with chronic urinary tract infections, definite response was seen in 7 cases and no definite response in 6 cases. Good results were obtained clinically in 4 cases for prophylaxis of postoperative infections. No side effect was observed with cephradine with cephradine throughout the experiment.

Pharmacokinetic interpretation of cephradine levels in serum after intravenous and extravascular administration in humans

Pharmacokinetic parameters were calculated from intravenous data based upon a two-compartment open model. These parameters were subsequently used to determine the absorption rates and bioavailability of cephradine administered intramuscularly and orally. The results indicate that cephradine obeys dose-independent kinetics and that biological availability is complete from all dosage forms.

Cephradine excretion in humans with pH-altered urine

In a random crossover study, ten healthy men were pretreated with ammonium chloride or sodium bicarbonate to alter urinary pH, and then were given a single 1-Gm dose of cephradine, either orally or intravenously. No significant changes were found in the terminal phase rate constant nor in the time or magnitude of peak concentration. Total recovery was greater than 90 per cent whenever degradation of cephradine did not occur. An unexplained but significant reduction in area under curve was present in data for prealkalinized subjects and for all subjects who took cephradine orally. Trapping of cephradine was not significant in the excretory pathway.

Cephradine in the treatment of chronic recurrent infections of the urinary tract

Twenty-two patients with chronic recurrent bacterial urinary tract infection, most of whom had underlying physical abnormalities of the tract, were treated with 500 mg cephradine 4-times daily for 10 to 15 days. Eight patients remained completely clear of infection after 2 to 3 months of treatment. This was regarded as a satisfactory result in view of the difficulty in treating this type of case and considering previous unsuccessful courses of antibacterial therapy.

The administration of cephradine to patients in renal failure

Cephradine was given to two control and twenty subjects with varying degrees of renal failure. Serum levels at various times were recorded and side-effects noted. Recommendations for dosage schedules for subjects with renal failure have been made.

A preliminary report on cephradine

Plasma cephradine levels were measured after parenteral and oral administration to healthy adults. Plasma cephradine contrations of 7 - 15 mug/ml were measured after 0.5 g had been administered by mouth, and concentrations of 12 - 57 mug/ml were measured after parenteral administration; they fell to 3 mug/ml within 240 minutes except after intramuscular administration. The results of an open clinical trial conducted among 10 patients suffering from urinary tract infections were satisfactory.

Sex differences in the intramuscular absorption and bioavailability of cephradine

Six male and six female volunteers each received a single intramuscular injection of cephradine, a new cephalosporin antibiotic, once weekly for 3 consecutive weeks. The drug was injected into the gluteus maximus, vastus lateralis, or deltoid muscle groups. Injection sites were rotated each week so that each subject received an injection into each muscle. Pharmacokinetic evaluation of serum concentrations and urinary excretion data indicated a sex difference with respect to the rate and extent of cephradine absorption from the three injection sites. Smaller areas under the curve and absorption rate constants were observed for females after injection into each muscle group. The most striking difference was observed when cephradine was injected into the gluteus maximus muscle, where the exponential function describing the alpha phase was observed to be 1.16 +/- 0.17 hr(-1) for females and 2.70 +/- 0.34 hr(-1) for males. Total area under the mean serum concentration-time curves, mean time to peak, and peak height parameters consistent with the slower rate of absorption and lesser bioavailability in females were observed. These results show that the vastus lateralis or deltoid muscle groups are preferable to the gluteus maximus as injection sites because of the more rapid rates of drug absorption from those muscles.

[Pharmacokinetics of intravenous Cefradin in normal and restricted renal function (author's transl)]

Half life and distribution volume of Cefradin were investigated in 22 patients with various degrees of renal function in which Cefradin was indicated and set in relation to glomerular filtration (determined by the 51Cr EDTA method). An average distribution volume of 21.8 +/- 3.5% of the body weight was found and a correlation between the half life of Cefradin and the glomerular filtration in the form of a power function. Estimations of levels were made from the pharmacokinetic data (half life, distribution volume) which serve as a basis for the recommendation of isoconcentration dosages. These are graduated according to the different degrees of renal insufficiency and given in tabular form for single injections and for continuous infusion drip therapy.

Clinical and laboratory evaluation of the effect of cephradine on patients with ear, nose and throat infections

27 patients with ear, nose and throat infections have been treated with cephradine orally. Ten patients received 250 mg and 17 patients 500 mg every 6 h during 10 days. 26 patients were cured. One patient failed to respond to treatment but reinfection could not be excluded. Determination of plasma concentrations showed that cephradine was well absorbed. The drug showed no severe adverse effects. Cephradine is a good replacement in patients with allergy to penicillins. It is also suitable when broad-spectrum therapy is needed.