Journal of Antimicrobial Chemotherapy (1978) 4 (Suppl. B), 231-233
Use of cefoxitin sodium in moderate to severe surgical infections
Department of Surgery, University of Health Sciences, The Chicago Medical School at Veterans Administration Hospital, North Chicago, Illinois, U.S.A. The activity of a new, broad-spectrum, semi-synthetic cephamycin antibiotic, cefoxitin sodium, was investigated in vivo. Of 50 patients studied, all with severe, moderate, or mild surgical infections, 88% responded well to cefoxitin therapy. Adverse reactions included 12 instances of phlebitis and 1 of maculopapular rash, but the incidence of phlebitis was probably related to the type of i.v. infusion system used.
Introduction The antibacterial spectrum of cefoxitin is considerably broader both in vitro and in vivo, than that of cephalosporins. Studies in vitro and in vivo have indicated that cefoxitin is active against Serratia marcescens, indole-positive Proteus, and anaerobic Gram-negative rods such as Bacteroides fragilis (Wallick & Hendlin, 1974). The latter anaerobes have characteristically been resistant to cephalosporins. The cephalosporin-sensitive bacteria, such as Escherichia coli, Klebsiella, indole-negative Proteus, Salmonella and Shigella are all sensitive to cefoxitin. Pseudomonas aeruginosa and enterococci are resistant both to existing cephalosporins and to cefoxitin (Neu, 1974). The purpose of this study was, first, to determine the efficacy of cefoxitin in treating surgical infections and, second, to determine any complications secondary to treatment. Patients and methods Fifty patients were studied. The average age was 54 years, and the average weight was 70-45 kg. There were 49 men and 1 woman. The patients' conditions ranged from excellent to poor, based on the number of physiologic impairments and background diseases. Two patients were in excellent condition, 26 in good condition, 13 in fair condition, and 9 in poor condition. Infections were rated severe, moderate, or mild: 13 were severe, 28 were moderate, and 9 were mild. The types of bacteria found in these infections are listed in Table I. The disease states treated in this study are shown in Table II. The daily dose of cefoxitin was 4 g for 20 patients, 6 g for 12 patients, and 8 g for 18 patients for a period of 5 to 20 days. A combination of gentamicin and cefoxitin was used in two instances of a mixed infection that included Pseudomonas aeruginosa. 231
Downloaded from http://jac.oxfordjournals.org/ at University of California, Santa Barbara on August 27, 2015
W. Schumer, R. L. Nichols and A. Acharya
232
W. Sctwmer, R. L. Nichols and A. Acharya
Table I. Bacterial aetiology Types of bacteria
No. of patients
Staphylococcus aureus Mixed infection (including Proteus, staphylococci, Bacteroides fragilis, and B. melaninogenicus Escherichia coli ^-haemolytic Streptococcus—Group A Proteus Klebsiella pneumoniae
14 13
Total
50
Table II. Disease states treated Disease states
No. of patients
Ccllulitis Acute urinary tract infection Intra-abdominal abscess Pneumonitis Wound infection Septicaemia—septic shock Chronic infected sinus Miscellaneous
14 10 7 6 6 2 2 3
Total
50
Results Cures were established clinically and bacteriologically. The cure rate was 88 %. There were no adverse laboratory experiences resulting from i.v. infusion of cefoxitin. In this small series, the only episode of resistance occurred in a patient (1 of the 13 having mixed infections) whose infection was a combination of Proteus and Staphylococcus aureus (Table I). The complication rate of 26% included 12 instances of phlebitis (24%) and 1 of maculopapular rash (2%). The most undesirable result of the i.v. infusion of cefoxitin was phlebitis. In searching for the cause of this effect, we found that phlebitis had also occurred in several studies of the i.v. infusion of cephalothin (Heseltine, Busch, Meyer & Finegold, 1976; Miao, Tally & Gorbach, 1976; Weinstein & Eickhoff, 1976). In local tolerance studies initiated by Merck Institute for Therapeutic Research,* it was determined that the type of i.v. infusion system affected the incidence of phlebitis.* The incidence of phlebitis was not related to the duration of each infusion or to the total duration of therapy. Use of an indwelling i.v. polyethylene catheter, however, significantly reduced the degree of local tolerance to the antibiotic. It should be noted that in our study, phlebitis occurred in the first 9 patients, all of whom had received cefoxitin through polyethylene catheters. When butterfly needles • Protocol cefoxitin (MK-306, Mefoxin*), Merck Institute for Therapeutic Research.
Downloaded from http://jac.oxfordjournals.org/ at University of California, Santa Barbara on August 27, 2015
9 6 4 4
Cefoxitin in surgical infections
233
were utilized for the next 41 patients, only 3 episodes of phlebitis occurred. Cefoxitin and cephalothin showed no significant difference with respect to local i.v. tolerance. Conclusion
References Heseltine, P. N. R., Busch, D. F., Meyer, R. D. & Finegold, S. M. Clinical experience with cefoxitin. Clinical Research 24: 113A (1976). Miao, P., Tally, F. P. & Gorbach, S. L. Treatment of bacterial infections with cefoxitin. 16th Interscience Conference on Antimicrobial Agents and Chemotherapy, 27-29 October, 1976, Chicago, III., U.S.A. Sponsored by the American Society for Microbiology; Tufts-New England Medical Center, Boston, Mass. Neu, H. Cefoxitin, A semisynthetic cephamycin antibiotic: antibacterial spectrum and resistance to hydrolysis by Gram-negative /3-lactamases. Antimicrobial Agents and Chemotherapy 6: 170-6 (1974). Wallick, H. & Hendlin, D. Cefoxitin, a semisynthetic cephamycin antibiotic: susceptibility studies. Antimicrobial Agents and Chemotherapy 5: 25-32 (1974). Weinstein, M. P. & Eickhoff, T. C. Cefoxitin therapy of acute bacterial infections. 16th Interscience Conference on Antimicrobial Agents and Chemotherapy, 27-29 October, 1976, Chicago, 111., U.S.A.
Downloaded from http://jac.oxfordjournals.org/ at University of California, Santa Barbara on August 27, 2015
From this study, the following conclusions were reached. 1. Treatment with cefoxitin sodium was effective in 88 % of patients with moderate to severe surgical infections. 2. Phlebitis occurred in 24% of the patients infused with cefoxitin. 3. No adverse laboratory experiences resulted from the i.v. infusion of cefoxitin.
Use of cefoxitin sodium in moderate to severe surgical infections
Department of Surgery, University of Health Sciences, The Chicago Medical School at Veterans Administration Hospital, North Chicago, Illinois, U.S.A. The activity of a new, broad-spectrum, semi-synthetic cephamycin antibiotic, cefoxitin sodium, was investigated in vivo. Of 50 patients studied, all with severe, moderate, or mild surgical infections, 88% responded well to cefoxitin therapy. Adverse reactions included 12 instances of phlebitis and 1 of maculopapular rash, but the incidence of phlebitis was probably related to the type of i.v. infusion system used.
Introduction The antibacterial spectrum of cefoxitin is considerably broader both in vitro and in vivo, than that of cephalosporins. Studies in vitro and in vivo have indicated that cefoxitin is active against Serratia marcescens, indole-positive Proteus, and anaerobic Gram-negative rods such as Bacteroides fragilis (Wallick & Hendlin, 1974). The latter anaerobes have characteristically been resistant to cephalosporins. The cephalosporin-sensitive bacteria, such as Escherichia coli, Klebsiella, indole-negative Proteus, Salmonella and Shigella are all sensitive to cefoxitin. Pseudomonas aeruginosa and enterococci are resistant both to existing cephalosporins and to cefoxitin (Neu, 1974). The purpose of this study was, first, to determine the efficacy of cefoxitin in treating surgical infections and, second, to determine any complications secondary to treatment. Patients and methods Fifty patients were studied. The average age was 54 years, and the average weight was 70-45 kg. There were 49 men and 1 woman. The patients' conditions ranged from excellent to poor, based on the number of physiologic impairments and background diseases. Two patients were in excellent condition, 26 in good condition, 13 in fair condition, and 9 in poor condition. Infections were rated severe, moderate, or mild: 13 were severe, 28 were moderate, and 9 were mild. The types of bacteria found in these infections are listed in Table I. The disease states treated in this study are shown in Table II. The daily dose of cefoxitin was 4 g for 20 patients, 6 g for 12 patients, and 8 g for 18 patients for a period of 5 to 20 days. A combination of gentamicin and cefoxitin was used in two instances of a mixed infection that included Pseudomonas aeruginosa. 231
Downloaded from http://jac.oxfordjournals.org/ at University of California, Santa Barbara on August 27, 2015
W. Schumer, R. L. Nichols and A. Acharya
232
W. Sctwmer, R. L. Nichols and A. Acharya
Table I. Bacterial aetiology Types of bacteria
No. of patients
Staphylococcus aureus Mixed infection (including Proteus, staphylococci, Bacteroides fragilis, and B. melaninogenicus Escherichia coli ^-haemolytic Streptococcus—Group A Proteus Klebsiella pneumoniae
14 13
Total
50
Table II. Disease states treated Disease states
No. of patients
Ccllulitis Acute urinary tract infection Intra-abdominal abscess Pneumonitis Wound infection Septicaemia—septic shock Chronic infected sinus Miscellaneous
14 10 7 6 6 2 2 3
Total
50
Results Cures were established clinically and bacteriologically. The cure rate was 88 %. There were no adverse laboratory experiences resulting from i.v. infusion of cefoxitin. In this small series, the only episode of resistance occurred in a patient (1 of the 13 having mixed infections) whose infection was a combination of Proteus and Staphylococcus aureus (Table I). The complication rate of 26% included 12 instances of phlebitis (24%) and 1 of maculopapular rash (2%). The most undesirable result of the i.v. infusion of cefoxitin was phlebitis. In searching for the cause of this effect, we found that phlebitis had also occurred in several studies of the i.v. infusion of cephalothin (Heseltine, Busch, Meyer & Finegold, 1976; Miao, Tally & Gorbach, 1976; Weinstein & Eickhoff, 1976). In local tolerance studies initiated by Merck Institute for Therapeutic Research,* it was determined that the type of i.v. infusion system affected the incidence of phlebitis.* The incidence of phlebitis was not related to the duration of each infusion or to the total duration of therapy. Use of an indwelling i.v. polyethylene catheter, however, significantly reduced the degree of local tolerance to the antibiotic. It should be noted that in our study, phlebitis occurred in the first 9 patients, all of whom had received cefoxitin through polyethylene catheters. When butterfly needles • Protocol cefoxitin (MK-306, Mefoxin*), Merck Institute for Therapeutic Research.
Downloaded from http://jac.oxfordjournals.org/ at University of California, Santa Barbara on August 27, 2015
9 6 4 4
Cefoxitin in surgical infections
233
were utilized for the next 41 patients, only 3 episodes of phlebitis occurred. Cefoxitin and cephalothin showed no significant difference with respect to local i.v. tolerance. Conclusion
References Heseltine, P. N. R., Busch, D. F., Meyer, R. D. & Finegold, S. M. Clinical experience with cefoxitin. Clinical Research 24: 113A (1976). Miao, P., Tally, F. P. & Gorbach, S. L. Treatment of bacterial infections with cefoxitin. 16th Interscience Conference on Antimicrobial Agents and Chemotherapy, 27-29 October, 1976, Chicago, III., U.S.A. Sponsored by the American Society for Microbiology; Tufts-New England Medical Center, Boston, Mass. Neu, H. Cefoxitin, A semisynthetic cephamycin antibiotic: antibacterial spectrum and resistance to hydrolysis by Gram-negative /3-lactamases. Antimicrobial Agents and Chemotherapy 6: 170-6 (1974). Wallick, H. & Hendlin, D. Cefoxitin, a semisynthetic cephamycin antibiotic: susceptibility studies. Antimicrobial Agents and Chemotherapy 5: 25-32 (1974). Weinstein, M. P. & Eickhoff, T. C. Cefoxitin therapy of acute bacterial infections. 16th Interscience Conference on Antimicrobial Agents and Chemotherapy, 27-29 October, 1976, Chicago, 111., U.S.A.
Downloaded from http://jac.oxfordjournals.org/ at University of California, Santa Barbara on August 27, 2015
From this study, the following conclusions were reached. 1. Treatment with cefoxitin sodium was effective in 88 % of patients with moderate to severe surgical infections. 2. Phlebitis occurred in 24% of the patients infused with cefoxitin. 3. No adverse laboratory experiences resulted from the i.v. infusion of cefoxitin.
