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.