[Effects of various antibiotic treatments of lactating cows with subclinical mastitis]

101 cows with 197 udder quarters with subclinical mastitis from 23 dairy farms were selected for different antibiotic treatments under field conditions. Group 1 consisting of 27 animals and 50 infected udder quarters was treated twice intramammaryly with 250 mg Cefacetril. Group 2 (26 animals/50 quarters) was treated twice intramuscular with 10 Mio IU Penethamathydrojodid and with 5 Mio IU respectively. Group 3 was treated twice with the combination of the intramammary and the intramuscular therapies in the above mentioned groups. Group 4 served as control. 23 animals with 36 subclinical infected udder quarters were treated twice intramuscular with 2.0 ml of sterile isotonic sodium-solution. Therapeutic success was controlled with bacteriological and cytological examinations of quarter milk probes one week, two weeks and four weeks after the end of treatments. Concerning bacteriological healing both the intramammary and the combined therapy had an even success with a 72.9% elimination rate of pathogenic bacteria whereas the intramuscular therapy led to bacteriological healing in 36.7%. In comparison cytological healing rates (< 100 x 10(3) cell counts per ml milk) with 29.8% in group 1, 32.3% in group 3 and 8.2% in group 2 were not satisfying. S. aureus was the predominating isolated bacteria. With respect to bacterial species found in the subclinically infected milk probes, elimination rates in Streptococcaceae and in Enterococcaceae was evident higher than in Staphylococcaceae. The results are discussed.

The cephalosporin antibiotics in pediatric therapy

The cephalosporins have been available for clinical use for nearly 20 years and a large number is presently marketed, including drugs with a wide range of different pharmacokinetic and microbiologic properties. While some of these agents have certain specific uses in which they excel, the cephalosporins have not replaced older antibiotics but do provide the physician with a broader range of choices for the treatment of many infections, allowing greater individualization of therapy.

[Efficiency of systemic prophylatic antibiotics in the surgical removal of lower widsom teeth]

The efficiency of prophylactically given systemic antibiotics was examined in a double-blind study on 142 patients on an ambulatory basis. It was found that the application of antibiotics do not significantly lower the rate of postoperative infections after the surgical removal of lower third molars.

Lack of penetration of cephacetril into the cerebro-spinal fluid of patients without meningitis

Six neurosurgical patients were given 2-4 g cephacetril intravenously at six hourly intervals. Serum and cerebrospinal fluid (CSF) concentrations were determined. Cephacetril activity was not detectable in the CSF when the blood-CSF barrier was intact. In two patients with increased CSF cell counts cephacetril was found in the CSF in low concentrations (0.1-0.8 mcg/ml). Our investigations show that cephacetril does not penetrate into the CSF unless there is an inflammation or other impairment of the blood-CSF barrier. Thus we could not confirm the results of some authors who found cephacetril in therapeutically effective concentrations in the CSF of healthy persons.

[Serum and joint levels of cefacetrile during its administration for septic arthritis]

Six patients, five of whom had normal and one impaired renal function, and all suffering from purulent arthritis caused by cephalosporin-sensitive germs, were given a seven-day course of 8 g cephacetrile daily. On the first day, 6 g were administered by continuous intravenous infusion at the rate of 500 mg/h, followed by 2 g over a further 45 min. On days 2 to 7, the patients received 2 short infusions of 4 g each at an interval of 12 h. In four patients with normal renal function, serum half-life ranged from 0.8 to 1.4 h, serum levels during continuous infusion from 19 to 31 microgram/ml, and total clearances from 265 to 434 ml/min. In one patients, these values were 1.6 h, 70 microgram/ml and 131 ml/min respectively (small volume of distribution). The concentrations in the synovial fluid varied from 2 to 29 mcirogram/ml; they were generally lower than the serum levels, but clearly exceeded the minimum inhibitory concentrations for germs commonly present in purulent arthritis. In five patients, the synovial fluid became germ-free and the arthritis was clinically cured. In the case presenting with renal insufficiency, the serum half-life was 5.8 h. During continuous administration, a steady state was not attained; peak serum levels amo9nted to 75 microgram/ml and the total clearance to 61 ml/min. The cephacetrile concentrations in the synovial fluid were very high (26 and 67 microgram/ml). In this case, in which the renal insufficiency associated with mycosis fungoides was present before the treatment, renal function deteriorated futher during treatment while the arthritis improved.

[A clinical evaluation of the effect of cephacetrile on bacterial pneumonia. A comparative test with cefazolin by a double blind method (author's transl)]

The therapeutic efficacy of cephacetrile (CEC) in bacterial pneumonia was evaluated in contrast with that of cefazolin (CEZ) by a double blind method. Both drugs were administered via intravenous route at a dose of 1 g twice daily for 14 days. 1) Of 81 patients, each 2 from both groups were eliminated from the study because of unknown results. In CEC group, 36 out of 38 obtained a slightly effective or better results (94.7% of effectiveness). In CEZ group, 31 out of 39 showed a similar result and there was no significant difference between the two groups. 2) In more detail, CEC achieved significantly better results in AaDo2 and cardiac insufficiency than CEZ, and this trend was also seen in dyspnea. 3) Regarding background factors, pretreatment severity was slightly in favor of CEC. However, so long as supplementary analysis is concerned, we could not find any relation between the pretreatment severity of symptom and drug efficacy or improvement of symptom. 4) Since there was a slight bias in the background factors, it is difficult to conclude that CEC is better than CEZ in terms of effectiveness. However, we consider CEC is superior to CEZ if compared in details. 5) Both drugs had the same incidence of side effect (6.25%, 3/48 in both groups). When clinical efficacy of CEC in bacterial pneumonia is evaluated together with the incidence of side effect, we may consider that CEC is an effective antibiotic agent equal to or better than CEZ.

[Comparative results of cephacetrile with cefazolin in complicated urinary tract infections by means of double-blind trials (author's transl)]

In order to elucidate the usefulness of cephacetrile (CEC), comparative trials with cefazolin (CEZ) were carried out in the patients with complicated infections of the urinary tract, and the following results were obtained: 1. There were no statistically significant differences or tendencies observed between the groups given CEC and CEZ in either of the global effects, bacteriological effects, rate of superinfection, relapse, relapse with bacterial alternation, drug usefulness, rate of improvements in symptoms and findings in all the cases. 2. According to a result of stratified analyses, there were statistically significant differences observed, showing more inferior results of CEC than CEZ in either stratum of "below 50" in the age, "acute" in the disease phase, "infections of the upper urinary tract" in the disease pattern, and "E. coli including mixed infections with gram-positive organisms" in the pathogenic strains. However, it should be taken into consideration that certain background factors influence greatly in the effects and there were some problems on deviated backgrounds in these strata. On the other hand, CEC displayed better bacteriological effects than those of CEZ in higher stratum of "chronic" in the disease phase and "Klebsiella, Proteus, Citrobacter, Enterobacter including mixed infections" in the pathogenic strains, and statistically significant differences were not observed. 3. In consequence of bacteriological studies, CEC showed stronger resistance than CEZ against beta-lactamase produced in all the strains of gram-negative bacilli. Particularly there were significant differences or tendencies observed in those of Proteus, Cirtobacter, and Enterobacter, and at the same time there were great differences in the activity of beta-lactamase between CEC and CEZ as the substrate. 4. In correlation of the MIC and effects, CEC showed weaker actions than CEZ against susceptible organisms, but slightly stronger actions against moderately or highly resistant strains. A study of the relationship between the MIC of pathogenic strains, beta-lactamase, and bacteriological effects, showed possibilities that even the high activity of beta-lactamase results in remarkable effects in susceptible strains and the drugs with stronger resistance against beta-lactamase given better results in moderately or highly resistant organisms. 5. The incidence rate of adverse reactions was 2 out of 51 cases in the CEC group (3.9%) and 3 out of 50 cases in the CEZ group (6.0%), showing no significant difference, and those symptoms were similar. In conclusion, when the usefulness of CEC in complicated infections of the urinary tract is compared with that of CEZ, the former is said to be equal to the latter without significant difference as a whole...

Cephacetrile, a new cephalosporin: in vitro, pharmacological and clinical evaluation

Cephacetrile, a parenteral cephalosporin, was evaluated for in vitro antibacterial activity, clinical pharmacology and effectiveness in the treatment of severe infections. The antibacterial activity against 187 isolates was determined by an agar-dilution technique. The MICs were 0.06 to 0.5 mug/ml for Group A Streptococcus, D. pneumoniae, and Staph. aureus, 4-6 mug/ml for E. coli and Klebsiella-Enterobacter 8-32 mug/ml for Pr. mirabilis and more than 500 mug/ml for Ps. aeruginosa. A few strains of Klebsiella and E. coli had MICs of more than 125 mcg/ml. Serum levels after 0.5 and 1 g of i.m. cephacetrile were respectively 14.6 and 18.6 mug/ml after 1 hr, and 1.5 and 2.5 mug/ml after 6 hr. Serum levels after i.v. infusion of 0.5 and 1 g were respectively 16 and 25 mug/ml after 1 hr., and 1 and 2 mug/ml after 6 hr. Urine levels after 0.5 and 1 g i.m. cephacetrile were respectively 500 and 650 mug/ml in the 0-3 hr period, and 250 and 300 mug/ml in the 3-6 hr period. Renal clearance was 166 +/- 5 ml/min/1.73 m2; renal excretion was about 20% of the dose 6 hr after i.m. injection. Cephacetrile was well tolerated when administered i.m. with lidocaine. Mild phlebitis occurred sometimes after i.v. infusions. The clinical response, evaluated in 36 patients with severe systemic, respiratory and urinary infections, was good in all but two cases.