Cefoxitin therapy in aerobic, anaerobic, and mixed aerobic-anaerobic infections

Prospective, Randomized Comparison of Ampicillin/Sulbactam and Cefoxitin for Diabetic Foot Infections

The purpose of this prospective, randomized, double-blind investigation was to compare two different parenteral antibiotics (ampicillin/sulbactam and cefoxitin) in conjunction with appropriate surgical procedures for treatment of patients with diabetic foot infec tions on a vascular surgery service. Thirty-six patients with diabetes mellitus who required hospitalization to treat foot infections were randomized into one of two treatment groups. There were 18 patients with similar baseline characteristics random ized to each treatment group. The Chi-square test was used for clinical and bacteriolog ical comparisons, the Wilcoxon rank sum test was used for comparing duration of hospi talization and clinical signs and symptoms, and Fisher's Exact Test (two-tailed) was used to compare treatment outcomes of the two groups. Based on intention-to-treat analysis, there was no significant difference in treatment outcome (cure + improved) between the ampicillin/sulbactam (15/17) and cefoxitin groups (16/17). Similarly, no significant differences in bacteriologic response were noted. Both ampicillin/sulbactam and cefoxitin, when combined with appropriate surgical interventions, are safe and effective therapies for treating foot infections in patients with diabetes mellitus.

The Cephalosporin Antibiotic Agents — II. First- and Second-Generation Agents

The first article in this series discussed the cephalosporin antibiotic agents as a class, including the similarities in their structure, antimicrobial action, and toxicity. Part II focuses on the difference between commercially available first- and second-“generation” agents.

The cephalosporins are classified using various criteria, including vulnerability to beta-lactamase hydrolysis and antibacterial activity. The latter classification is based on the in vitro activity of the individual agents, with each succeeding “generation” possessing a greater spectrum of activity than the previous generation(s).

Cefoxitin in the prevention and treatment of infections

A review of the literature indicates that cefoxitin is an effective single-agent therapy for community-acquired intra-abdominal infections, pelvic infections, and surgical prophylaxis. Hospital-acquired intra-abdominal infections may require the addition of an aminoglycoside.

Treatment of respiratory tract infections with cephalosporin antibiotics

Infections of the respiratory tract are among the most common causes for antibiotic prescribing. Their diagnosis within the community is generally limited to clinical criteria, and microbiological information is frequently lacking. Hospitalised patients with respiratory tract infections are more likely to undergo diagnostic sampling, but difficulties remain in reliably defining a microbial aetiology, thereby providing a confident basis for antibiotic selection. In considering the role of the cephalosporins in the treatment of respiratory tract infections, over 500 published articles have been reviewed. The pharmacokinetic considerations are discussed and the limitations of existing methodology are emphasised. Individual agents are reviewed by site of sepsis and conclusions are drawn from both comparative and non-comparative studies and in relation to currently recommended regimens. Although oral cephalosporins are widely used to treat upper respiratory tract infections, none is considered ideal, especially where Haemophilus influenzae is pathogenic. In the case of lower respiratory tract infections the beta-lactamase stable parenteral cephalosporins have become widely used to treat pneumonia in hospitalised patients, especially where Gram-negative enteric bacilli are of aetiological importance. However, the lack of activity of these drugs against Legionella spp., Mycoplasma pneumoniae and Coxiella burnetii must be emphasised. Another area of increasing use is in the treatment of infective exacerbations in patients suffering from cystic fibrosis of the lungs where Pseudomonas aeruginosa is pathogenic; ceftazidime in particular has proved a useful alternative to earlier antipseudomonal penicillin antibiotics.