Journal of Antimicrobial Chamotherapy (1978) 4 {Suppl. B), 179-182
Clinical evaluation of cefoxitin sodium in different types of infection
D. Stamboulian J. Petrolito and J. M. Colombo
Cefoxitin sodium was used to treat 53 patients with different types of documented bacterial infection. Clinical and bacteriological cure was achieved in 90% of the cases. Injections of cefoxitin i.v., and i.m. with lidocaine 0-5 or 1-0%, were satisfactorily tolerated. There were no serious side effects. Cefoxitin appears to be safe and effective in treating moderate and severe bacterial infections caused by Grampositive or Gram-negative organisms.
Introduction According to our in vitro study, as well as from the data of other investigators (Moellering, Dray & Kunz, 1974; Adams, Stilwell & Turk, 1976; Sutter & Finegold, 1975), cefoxitin sodium emerges as a broad-spectrum antibiotic useful against many different types of infections. The present study was carried out to evaluate the efficacy, safety, and tolerance of cefoxitin in adults hospitalized for acute infections. Materials and methods Fifty-three patients with urinary, respiratory, skin/soft tissue, and septic infections were treated with cefoxitin between July and December 1976 (Table I). Criteria for inclusion in the study were the presence of acute bacterial infections caused by pathogenic organisms sensitive to cefoxitin. Those patients with severe infections were treated with cefoxitin i.v., 2 g every 8 h until there was evidence of improvement, followed by i.m. therapy of 1 g of cefoxitin every 8 h, with 0-5 or 1 0 % lidocaine used as diluent. Patients with moderate infections received 1 g of cefoxitin i.m. every 8 h, with 0-5 or 1 0 % lidocaine as diluent. In all cases, the patients were clinically evaluated before, during, and after therapy, in order to determine the response, any side effects, and the occurrence of any allergic reactions. Appropriate bacteriological studies were carried out in all patients, from blood and from the suspected sites of infection (bronchial secretion collected by transtracheal 179
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Infectious Diseases Unit, Professor A. Posadas Hospital, Buenos Aires, Argentina
180
D. Stamboolian, J. Petrolito and J. M. Colombo
aspiration, sputum, urine, woundfluids,etc.). The following standard laboratory measurements were made for all patients before and after therapy: haemoglobin, haematocrit, white blood count (WBC) and differential blood count, platelet count, blood urea nitrogen (BUN) or creatinine, alkaline phosphatase, bilirubin, serum transaminases, and urinalysis.
Table I. Patients and modes of therapy used in the clinical evaluation of cefoxitin No. of patients
Parenteral (i.v. and i.m.) Intramuscular only
16 37
Total
53
Results Of 53 patients, 16 were treated by both i.v. and i.m. routes and 37 by the i.m. route only (Table I). Twenty-four patients (45 %) had urinary tract infections, 17 (32 %) had respiratory infections (mostly bacterial pneumonia), 8 (15%) had infections of the skin and soft tissues, and 4 (8 %) had sepsis (Table II). Table II. Types of infections and numbers of patients having pathogenic organisms (total 53 patients) Type of infection Acute urinary tract
Respiratory tract
Skin soft tissue
Sepsis
Pathogen
No. of patients
Escherichia coli Proteus mirabilis Kltbsiella pneumoniae Proteus morganii Total
17 (71 %) 3 3 1 24
Total
12 (71 %) 2 1 1 1 17
Total
5(63%) 1 2 8
Total
2(50%) 1 1 4
Streptococcus pneumoniae K. pneumoniae Streptococcus (non-haemolytic) Group A streptococci Staphylococcus (coagulase + )
Staphylococcus (coagulase + ) P. mirabilis K. pneumoniae Staphylococcus (coagulase + ) Staphylococcus (coagulase —) K. pneumoniae
Coagulase + — coagulase positive; coagulase — = coagulase negative.
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Mode of therapy
Clinical evaluation in different infections
181
The predominant pathogens found in the different types of infections were: Escherichia coli in the urinary tract; Streptococcus pneumoniae in the respiratory tract; and Staphylococcus aureus in skin/soft tissues and sepsis (Table II). Most patients on i.m. therapy with cefoxitin received the drug for 10 days; in the group treated both i.v. and i.m., most patients received cefoxitin for 14 days (Table III). Table i n . Route, dosage and duration of therapy among 53 patients treated with cefoxitin
Intramuscular onlyt (37 patients with milder infections)
Intravenous and intramuscular* (16 patients with more severe infections)
No. of patients
4 7 8 9 10 11 12
1 3 5 1 23 3 1
12 21 24 27 30 33 36
8 10 11 13 14
1 5 1 1 8
33 39 51 48 54
(g)
* Dosage i.m.: 1-Og every 8 h, with 0-5 or 1-O%lidocaine as diluent. t Dosage i.v. initially until improvement: 2-0 g every 8 h, followed by i.m. therapy, 1-0 g every 8 h, with 0-5 or 1 0 % lidocaine as diluent
Clinical and bacteriological cure was achieved in 50 of the 53 cases (a 94-3% cure rate); 2 patients improved and 1 failed to respond to therapy (Tables IV and V). Discussion The present study confirms the efficacy and safety of cefoxitin sodium in the treatment of moderate and severe bacterial infections of several kinds. Clinical and bacteriological cure was achieved in approximately 90 % of the patients. One reason for this high percentage of cured patients was patient selection. Patients with associated pathology, or those compromised in a way that could interfere with the response to antibiotics, were excluded. Additionally, we excluded those patients with a history of chronic or recurrent infections. Table IV. Clinical outcome of cefoxitin therapy Clinical outcome
No. of patients
Per cent of patients
Cured Improved Did not improve
50 2 1
94-3 3-8 1 -9
Total * Acute pyelonephritis due to Proteus mirabilis.
53
1000
Downloaded from http://jac.oxfordjournals.org/ at Georgetown University on August 26, 2015
Route
Total doses/patient
Duration of treatment (days)
182
D. Stamboulian, J. Petrolito and J. M. Colombo Table V. Bacteriological outcome of cefoxitin therapy Bacteriological outcome
No. of cases
Pathogen eradicated Pathogen persisted still sensitive Primary sensitive pathogen suppressed
50(94-3%) 2 (3-8%) 1 (1-9%) Total
53 (100%)
Table VI. Local tolerance to intramuscular injection of cefoxitin (with lidocaine 0-5 to 1 0%) Tolerance
No. of patients
Well tolerated Moderately tolerated Total
Per cent of patients
48 5
90-6 9-4
53
100-0
Cefoxitin sodium appears to be a nontoxic antibiotic useful in acute bacterial injections. Acute urinary tract, respiratory tract, skin/soft-tissue infections, and septicaemia, all caused by Gram-positive or Gram-negative organisms, responded satisfactorily to cefoxitin therapy. References Moellering, R. C. Jr., Dray, M. & Kunz, L. J. Susceptibility of clinical isolates of bacteria to cefoxitin and cephalothin. Antimicrobial Agents and Chemotherapy 6: 320-3 (1974). Adams, H. G., Stilwell, G. A. & Turk, M. In vitro evaluation of cefoxitin and cefamandole. Antimicrobial Agents and Chemotherapy 9: 1019-24 (1976). Sutter, V. L. & Finegold, S. M. Susceptibility of anaerobic bacteria to carbenicillin, cefoxitin and related drugs. Journal of Infectious Diseases 131: 417-22 (1975).
Downloaded from http://jac.oxfordjournals.org/ at Georgetown University on August 26, 2015
The drug was safe and very well tolerated both i.v. and i.m. Only 1 patient had phlebitis, but 5 experienced some local pain, induration, or both after i.m. injection of cefoxitin with lidocaine, 0-5 or 1-0% (Table VI).
Clinical evaluation of cefoxitin sodium in different types of infection
D. Stamboulian J. Petrolito and J. M. Colombo
Cefoxitin sodium was used to treat 53 patients with different types of documented bacterial infection. Clinical and bacteriological cure was achieved in 90% of the cases. Injections of cefoxitin i.v., and i.m. with lidocaine 0-5 or 1-0%, were satisfactorily tolerated. There were no serious side effects. Cefoxitin appears to be safe and effective in treating moderate and severe bacterial infections caused by Grampositive or Gram-negative organisms.
Introduction According to our in vitro study, as well as from the data of other investigators (Moellering, Dray & Kunz, 1974; Adams, Stilwell & Turk, 1976; Sutter & Finegold, 1975), cefoxitin sodium emerges as a broad-spectrum antibiotic useful against many different types of infections. The present study was carried out to evaluate the efficacy, safety, and tolerance of cefoxitin in adults hospitalized for acute infections. Materials and methods Fifty-three patients with urinary, respiratory, skin/soft tissue, and septic infections were treated with cefoxitin between July and December 1976 (Table I). Criteria for inclusion in the study were the presence of acute bacterial infections caused by pathogenic organisms sensitive to cefoxitin. Those patients with severe infections were treated with cefoxitin i.v., 2 g every 8 h until there was evidence of improvement, followed by i.m. therapy of 1 g of cefoxitin every 8 h, with 0-5 or 1 0 % lidocaine used as diluent. Patients with moderate infections received 1 g of cefoxitin i.m. every 8 h, with 0-5 or 1 0 % lidocaine as diluent. In all cases, the patients were clinically evaluated before, during, and after therapy, in order to determine the response, any side effects, and the occurrence of any allergic reactions. Appropriate bacteriological studies were carried out in all patients, from blood and from the suspected sites of infection (bronchial secretion collected by transtracheal 179
Downloaded from http://jac.oxfordjournals.org/ at Georgetown University on August 26, 2015
Infectious Diseases Unit, Professor A. Posadas Hospital, Buenos Aires, Argentina
180
D. Stamboolian, J. Petrolito and J. M. Colombo
aspiration, sputum, urine, woundfluids,etc.). The following standard laboratory measurements were made for all patients before and after therapy: haemoglobin, haematocrit, white blood count (WBC) and differential blood count, platelet count, blood urea nitrogen (BUN) or creatinine, alkaline phosphatase, bilirubin, serum transaminases, and urinalysis.
Table I. Patients and modes of therapy used in the clinical evaluation of cefoxitin No. of patients
Parenteral (i.v. and i.m.) Intramuscular only
16 37
Total
53
Results Of 53 patients, 16 were treated by both i.v. and i.m. routes and 37 by the i.m. route only (Table I). Twenty-four patients (45 %) had urinary tract infections, 17 (32 %) had respiratory infections (mostly bacterial pneumonia), 8 (15%) had infections of the skin and soft tissues, and 4 (8 %) had sepsis (Table II). Table II. Types of infections and numbers of patients having pathogenic organisms (total 53 patients) Type of infection Acute urinary tract
Respiratory tract
Skin soft tissue
Sepsis
Pathogen
No. of patients
Escherichia coli Proteus mirabilis Kltbsiella pneumoniae Proteus morganii Total
17 (71 %) 3 3 1 24
Total
12 (71 %) 2 1 1 1 17
Total
5(63%) 1 2 8
Total
2(50%) 1 1 4
Streptococcus pneumoniae K. pneumoniae Streptococcus (non-haemolytic) Group A streptococci Staphylococcus (coagulase + )
Staphylococcus (coagulase + ) P. mirabilis K. pneumoniae Staphylococcus (coagulase + ) Staphylococcus (coagulase —) K. pneumoniae
Coagulase + — coagulase positive; coagulase — = coagulase negative.
Downloaded from http://jac.oxfordjournals.org/ at Georgetown University on August 26, 2015
Mode of therapy
Clinical evaluation in different infections
181
The predominant pathogens found in the different types of infections were: Escherichia coli in the urinary tract; Streptococcus pneumoniae in the respiratory tract; and Staphylococcus aureus in skin/soft tissues and sepsis (Table II). Most patients on i.m. therapy with cefoxitin received the drug for 10 days; in the group treated both i.v. and i.m., most patients received cefoxitin for 14 days (Table III). Table i n . Route, dosage and duration of therapy among 53 patients treated with cefoxitin
Intramuscular onlyt (37 patients with milder infections)
Intravenous and intramuscular* (16 patients with more severe infections)
No. of patients
4 7 8 9 10 11 12
1 3 5 1 23 3 1
12 21 24 27 30 33 36
8 10 11 13 14
1 5 1 1 8
33 39 51 48 54
(g)
* Dosage i.m.: 1-Og every 8 h, with 0-5 or 1-O%lidocaine as diluent. t Dosage i.v. initially until improvement: 2-0 g every 8 h, followed by i.m. therapy, 1-0 g every 8 h, with 0-5 or 1 0 % lidocaine as diluent
Clinical and bacteriological cure was achieved in 50 of the 53 cases (a 94-3% cure rate); 2 patients improved and 1 failed to respond to therapy (Tables IV and V). Discussion The present study confirms the efficacy and safety of cefoxitin sodium in the treatment of moderate and severe bacterial infections of several kinds. Clinical and bacteriological cure was achieved in approximately 90 % of the patients. One reason for this high percentage of cured patients was patient selection. Patients with associated pathology, or those compromised in a way that could interfere with the response to antibiotics, were excluded. Additionally, we excluded those patients with a history of chronic or recurrent infections. Table IV. Clinical outcome of cefoxitin therapy Clinical outcome
No. of patients
Per cent of patients
Cured Improved Did not improve
50 2 1
94-3 3-8 1 -9
Total * Acute pyelonephritis due to Proteus mirabilis.
53
1000
Downloaded from http://jac.oxfordjournals.org/ at Georgetown University on August 26, 2015
Route
Total doses/patient
Duration of treatment (days)
182
D. Stamboulian, J. Petrolito and J. M. Colombo Table V. Bacteriological outcome of cefoxitin therapy Bacteriological outcome
No. of cases
Pathogen eradicated Pathogen persisted still sensitive Primary sensitive pathogen suppressed
50(94-3%) 2 (3-8%) 1 (1-9%) Total
53 (100%)
Table VI. Local tolerance to intramuscular injection of cefoxitin (with lidocaine 0-5 to 1 0%) Tolerance
No. of patients
Well tolerated Moderately tolerated Total
Per cent of patients
48 5
90-6 9-4
53
100-0
Cefoxitin sodium appears to be a nontoxic antibiotic useful in acute bacterial injections. Acute urinary tract, respiratory tract, skin/soft-tissue infections, and septicaemia, all caused by Gram-positive or Gram-negative organisms, responded satisfactorily to cefoxitin therapy. References Moellering, R. C. Jr., Dray, M. & Kunz, L. J. Susceptibility of clinical isolates of bacteria to cefoxitin and cephalothin. Antimicrobial Agents and Chemotherapy 6: 320-3 (1974). Adams, H. G., Stilwell, G. A. & Turk, M. In vitro evaluation of cefoxitin and cefamandole. Antimicrobial Agents and Chemotherapy 9: 1019-24 (1976). Sutter, V. L. & Finegold, S. M. Susceptibility of anaerobic bacteria to carbenicillin, cefoxitin and related drugs. Journal of Infectious Diseases 131: 417-22 (1975).
Downloaded from http://jac.oxfordjournals.org/ at Georgetown University on August 26, 2015
The drug was safe and very well tolerated both i.v. and i.m. Only 1 patient had phlebitis, but 5 experienced some local pain, induration, or both after i.m. injection of cefoxitin with lidocaine, 0-5 or 1-0% (Table VI).
