In vitro activity of moxalactam alone and in combination with penicillin against common meningeal pathogens

Cephalosporins in gram-positive infections

Infections caused by Gram-positive bacteria are an important and common cause of morbidity and mortality. Staphylococci and streptococci are the most frequent infecting organisms in skin and soft tissue infections, pneumonia, bone and joint infections, and endocarditis. Anaerobic Gram-positive bacteria such as Clostridia spp. cause infections that can rapidly produce tissue necrosis and death. The cephalosporins are indicated for the treatment of infections caused by Gram-positive bacteria in certain circumstances. These include selected patients with endocarditis, osteomyelitis, septic arthritis and cellulitis. They are also used as alternatives to the penicillins in penicillin-allergic patients and for 'mixed' infections caused by Gram-positive and Gram-negative organisms. This article discusses the indications for the cephalosporin group of antibiotics in patients suffering from infections caused by Gram-positive bacteria.

Cefmenoxime. Clinical, bacteriologic, and pharmacologic studies

Cefmenoxime, a new semisynthetic third-generation cephalosporin, was evaluated in 105 patients (45 men and 60 women) with the following infections: skin or skin structure (33), pulmonary (22), urinary tract (30), and septicemia (20). Forty-two infections were hospital-acquired, 85 patients had underlying diseases, 29 patients required concomitant surgery, and 32 patients had positive results of blood culture. Cefmenoxime dosages ranged from 4 to 12 g per day intravenously for one and a half to 51 days. Cultures revealed 183 organisms in the 105 patients. Minimal inhibitory concentrations were obtained for cefmenoxime, cefoperazone, cefotaxime, cefamandole, cefoxitin, and moxalactam. Cefmenoxime and cefotaxime exhibited nearly equivalent activities against all organisms tested and were the most active agents tested against all aerobic and facultative organisms except Staphylococcus aureus. Mean serum peak and trough levels obtained after 2 g every six hours were 84.1 micrograms/ml (peak), 8.3 micrograms/ml (trough); and after 2 g every four hours, 106 micrograms/ml (peak) and 10.9 micrograms/ml (trough). Of 105 infections, 86 were clinically cured, three were not cured, and 16 were not evaluable. Safety studies revealed 24 transient reactions in 23 patients including eosinophilia, diarrhea, leukopenia, rash, elevated liver enzyme levels, Antabuse effect, and phlebitis. On the basis of these clinical and in vitro results, cefmenoxime is a safe drug for the treatment of infections caused by gram-negative and gram-positive aerobic organisms.