Comparative incidence of phlebitis due to buffered cephalothin, cephapirin, and cefamandole

Failure of intravenous infusions from extravasation and phlebitis

A survey was done to compare the rates at which phlebitis and extravasation cause failure of intravenous infusions lasting more than 24 hours. Slightly more infusions failed due to phlebitis than to extravasation but extravasation did not occur earlier or later than phlebitis or differ significantly from it in frequency when different types of infusions were compared. Univariate life table analysis indicated that the co-infusion of blood, potassium or cephalosporin antibiotics slightly increased and that higher flow rates markedly increased failure, that infusions including continuous heparin and steroids had markedly decreased failure, and that failure was not significantly affected by other antibiotics or by differences in sex, age, location of infusion site or time of year. Multivariate analysis showed that the above differences were statistically significant only for infusion rate, heparin and steroids.

Side effects of cephalosporins

Cephalosporins generally cause few side effects. Hypersensitivity reactions are less common than with the penicillins and modern studies have presented data contradicting a true cross-reactivity to cephalosporins in patients who have previously reacted to penicillins. Other hypersensitivity reactions to cephalosporins include fever, arthralgia and exanthema observed in two clusters of children who had been given cefaclor. Nephrotoxicity is not a problem with modern cephalosporins, although slight reductions of renal function have been seen when high doses of ceftazidime were used. Some of the new cephalosporins have a 3-methyl thiotetrazole side-chain, a moiety which confers a risk of reduced synthesis of prothrombin with subsequent risk of bleeding, and of disulfiram-like reactions in patients consuming alcohol following a cephalosporin dose. Other cephalosporins, e.g. ceftriaxone and cefoperazone, are excreted not only via the kidneys but also via the bile. This leads to high biliary concentrations of the active drug, increasing the risk of diarrhoea which may be caused by selection of cytotoxin-producing strains of Clostridium difficile. Laboratory adverse reactions to cephalosporins are rare. Eosinophilia and thrombocytosis are commonly reported, but are most probably not adverse reactions but signs of healing of the infections treated. Other haematological reactions have been reported in very few patients and have been rapidly reversible when treatment was stopped.

Drug-induced fever

Humans maintain body temperature within a narrow range. Drug administration can upset the usual balance and cause a fever. The drug may interfere with heat dissipation peripherally, increase the rate of metabolism, evoke a cellular or humoral immune response, mimic endogenous pyrogen, or damage tissues. The fever may be a result of the pharmacological action of the drug or some other unrelated effect. Drug-induced fever is most commonly the result of a hypersensitivity reaction and its characteristics resemble those of an allergic reaction. The fever most commonly occurs after 7 to 10 days of drug administration, persists as long as the drug is continued, disappears soon after stopping the drug, and will rapidly reappear if the drug is restarted. The agents most commonly associated with causing fever include the penicillins, cephalosporins, antituberculars, quinidine, procainamide, methyldopa, and phenytoin.

The clinical use of cephapirin sodium in total hip arthroplasty and measurement of plasma and bone levels

Cephapirin sodium, a new parenteral cephalosporin antibiotic recommended for use perioperatively, was administered to 50 consecutive patients undergoing total hip arthroplasty. Blood and bone concentrations extracted simultaneously were measured, and excellent penetration of cephapirin into bone was demonstrated. No infection was observed in any patient after surgery. Few instances of adverse reactions were noted. Although some patients developed phlebitis, no case was severe.

Cefamandole nafate: an evaluation of antibacterial activity, serum levels, clinical effect, and incidence of side reactions in 58 patients

35 males and 23 females with skin and soft tissue infection, lower respiratory tract infection, urinary tract infection or septicemia with known etiology were treated with cefamandole nafate. The patients were to a large extent (30%) alcoholics and/or drug abusers. Cefamandole was given intravenously as 4 daily doses of 1 g in 52 cases and of 2 g in 6 cases for 8 to 16 (mean 10) days. The effect was considered to be good in 40 patients (70%). Adverse reactions, mostly slight and transient, were seen in 22 patients (38%). Peak serum levels varied from 26 to 82 (mean 50) micrograms/ml after 1 g doses and from 68 to 100 micrograms/ml after 2 g. Previous statements of a better in vitro activity of cefamandole than of older cephalosporins against some gram-negative bacilli were corroborated.

Therapy of serious infections with cefamandole

Forty-four patients with serious bacterial infections were treated with cefamandole in a dose 1--2 g every four to six hours. Thirty-two patients were cured and six were markedly improved. Three of six failures were due to superinfection with cephalothin-resistant microorganisms. The over-all bacteriologic response was 80%. In 12 of 13 patients with bacteremia the blood was sterilized. Ten of 14 patients with gram-negative bacillary infections responded to treatment. Six of these were due to cephalothin-resistant microorganisms, three of which responded. Fifteen patients who were treated had a history of penicillin allergy. There were no serious reactions although skin rash did develop. Phlebitis was uncommon.

Cefoxitin: clinical evaluation in thirty-eight patients

Clinical and bacteriological efficacy, patient tolerance, and toxicity of cefoxitin, a beta-lactamase-resistant cephamycin, were evaluated in 38 patients; 13 had soft tissue infection, 12 had pneumonia, 3 had urinary tract infection, 2 had peritonitis, and 4 had miscellaneous infections. In five patients, infection was clinically evident, though not bacteriologically proven. The latter patients were evaluated with regard to tolerance and toxicity only. Among the 34 infections in 33 patients, 71% were considered clinically cured; 86% of those patients who could be recultured were bacteriologically cured. Phlebitis was noted in 32% of the total group, and eosinophilia was observed in 16%. Unexplained deterioration in renal function occurred in two patients. Mean peak cefoxitin levels in serum were 72 mug/ml 30 min after a 2-g infusion and 32 mug/ml 30 min after a 1-g infusion. Cefoxitin was more active against facultatively and obligately anaerobic gram-negative organisms isolated from these patients than was cephalothin.