Cefamandole therapy in anaerobic infections

Moxalactam in the therapy of serious infections

Sixty-seven patients were treated with moxalactam in a noncomparative trial of hospitalized patients; 32 had endometritis or chorioamnionitis, 12 had skin and soft tissue infections, 5 had osteomyelitis, 5 had pneumonia, 5 had urinary tract infections, 4 had arthritis, 2 had sepsis from an unknown source, 1 had endocarditis, and 1 had peritonitis. Bacteremia was present in 12 of these patients. Patients were given 3 to 12 g of moxalactam per day (mean, 6.24 g/day) in divided doses every 6 to 8 h. Seven patients were given intramuscular treatment for 3 to 20 days for part or all of their therapy. The rest were given intravenous treatment exclusively. Treatment was continued for 2 to 42 days (mean, 10 days). The dose and the duration of therapy were determined by the type of infection and the response of each patient. There were four treatment failures and one enterococcal-clostridial superinfection. Moxalactam was well tolerated. Allergic reactions led to the discontinuation of the antibiotic in three patients. Prolonged prothrombin and partial thromboplastin times were observed in 2 of 11 patients tested; in both instances in patients had severe underlying diseases, including malnutrition and alcoholism. Pain on intramuscular injection was noted in two patients receiving 1,500 mg, but not in five receiving a lower dose; in one case the pain forced the use of intravenous therapy after one dose, and in the other case the pain was mild and the patient was treated for 20 days. We concluded that moxalactam was effective in the treatment of the types of infections included in this study and produced few adverse reactions.

N-formimidoyl thienamycin (MK0787): in vitro activity against anaerobic bacteria

The in vitro activity of N-formimidoyl thienamycin (MK0787) was tested against 239 anaerobic bacteria clinical isolates: 70 of Bacteroides fragilis, 18 of B. distasonis, 16 of B. thetaiotaomicron, 10 of B. vulgatus, 24 of Bacteroides spp., 22 of B. melaninogenicus (all three subspecies), 26 of Fusobacterium spp., 10 of Peptococcus spp., 15 of Peptostreptococcus spp., 15 of Clostridium perfringens, and 13 of Clostridium spp. Ninety-five percent of the isolates were inhibited by less than or equal to 0.125 microgram/ml, and all were inhibited by less than or equal to 4 micrograms/ml.

Cefamandole preparation for colonic surgery

A controlled, prospective, randomized study of 457 patients undergoing colonic surgery was done to compare systemic cefamandole therapy to neomycin-erythromycin in reducing postoperative septic complications. Parenteral cefamandole and cephalothin were given before, during, and after surgery to achieve maximal antimicrobial coverage in the blood, tissues, peritoneum, and urine. Such protection is not obtained with oral antibiotic preparation. Major surgical indications were carcinoma in 216 patients and diverticulitis in 107 patients. More than half the patients had colonic perforations, obstruction, or fistulas. All patients were operated upon by a single surgeon during 1975-1980. Cephalothin (151 patients), combined with neomycin-erythromycin, resulted in an 11.3 per cent rate of postoperative septic complications. Cefamandole treatment in 112 patients resulted in an 8.9 per cent postoperative infection rate compared with 16.3 per cent in 141 matched control patients.

Pharmacology, Safety, and efficacy of cefamandole in childhood infections

We used cefamandole in the initial treatment of 34 children (10 months to 15 years of age) with suspected bone, joint, or soft tissue infections. The minimal inhibitory concentration of organisms encountered ranged between 0.015 and 2 microgram/ml. At 1 h after intravenous infusion of 25 mg/kg, the mean serum level of cefamandole was 26.2 microgram/ml (range, 8.9 to 47.5 microgram/ml), and at 3 h the level was 1.8 microgram/ml (range, 0.6 to 4.4 microgram/ml), which is above the minimal inhibitory concentration for most of the organisms encountered. However, when the drug was given intravenously every 6 h, the mean level after a 37-mg/kg dose was 0.9 microgram/ml (range, less than 0.5 to 1.9 microgram/ml) at 4 h and, by extrapolation, would have fallen below 0.1 microgram/ml at 6 h. The mean serum half-life was 34 min. Cefamandole appeared to diffuse well into synovial fluid, with joint fluid levels between 5 and 40 microgram/ml. The drug was tolerated well. Cefamandole appears to be a reasonable alternative in the initial treatment of skeletal infections in children, but need to be administered every 4 h to maintain suprainhibitory serum levels between doses.

Group B beta-hemolytic streptococci and puerperal infections

Group B beta-hemolytic streptococci as a major cause of puerperal infection in 40 patients is described. Unique features of this bacterial infection are the development of an average peak oral temperature within 12 hours of delivery, tachycardia, distended abdomen, and endomyometritis or endomyoparametritis. Bacteremia occurred in 35% of these patients.