Cefamandole and cefazolin in the therapy of complicated urinary tract infections

First-generation cephalosporins for the treatment of complicated upper urinary tract infection in adults: A systematic literature review

INTRODUCTION

Complicated upper urinary tract infection (UTI) is a significant cause of infectious morbidity and in-hospital antibiotic therapy. However, the use of first-generation cephalosporins in this scenario is not clearly defined.

OBJECTIVE

Evaluate the efficacy and safety of first-generation cephalosporins for community-acquired complicated upper UTI in adults requiring hospital care.

METHODS

Systematic review by searching in electronic databases (MEDLINE, Embase, CENTRAL) and trials registers, with screened and selected the references, data extraction and risk of bias assessment. The results were presented in a narrative synthesis.

RESULTS

Seven randomized clinical trials were included. We did not identify statistically significant differences when comparing first-generation cephalosporins with other antimicrobials for outcomes of clinical cure, length of hospital stay, and reinfection. However, a lower probability of microbiological cure and a higher probability of relapse were identified in the first-generation cephalosporin group in 3 of 7 studies and in 2 of 5 studies, respectively. No serious adverse effects were reported.

CONCLUSIONS

First-generation cephalosporins could be a potential therapy in this setting, nevertheless it should be considered the low quality of evidence for analyzed outcomes, due to limitations of risk of bias and imprecision. It is essential to carry out comparative studies in which the benefits and harms of these antibiotics are evaluated.

Cefazolin and enterobacteriaceae: rationale for revised susceptibility testing breakpoints

Clinical and Laboratory Standards Institute breakpoints for cefazolin against Enterobacteriaceae that were published in January 2010 have been revised by the Subcommittee on Antimicrobial Susceptibility Testing, based on the examination of recent data about in vitro activity, pharmacokinetic-pharmacodynamic characteristics and published clinical outcome studies. The new breakpoints, to be formally published in January 2011, have increased the minimum inhibitory concentration interpretive criteria by one 2-fold dilution, linked to an adult dosing schedule of 2 g every 8 h intravenously. Disk diffusion zone diameter correlates, shown to be impossible to define with the January 2010 interpretive criteria, have been able to be set for the new interpretive criteria. Diagnostic laboratories will continue to need to test cephalothin to predict susceptibility to the oral cephalosporins cefadroxil, cefpodoxime, cephalexin, and loracarbef.

Clinical comparison of piperacillin and cefamandole in treatment of complicated urinary tract infections

The efficacy and safety of piperacillin were compared with those of cefamandole in 72 patients (mean age: 63 years) with complicated urinary tract infections. Efficacy was evaluable in 25/34 piperacillin-treated patients (12 Gm/day) and in 23/38 cefamandole-treated patients (6 Gm/day). Clinical cure or improvement was noted in all patients who were given piperacillin and in 96 per cent (22/23) of those who received cefamandole. Seventy-one per cent (41/58) of the organisms cultured pretherapy were gram-negative aerobic bacteria. Escherichia coli was the most frequently isolated organism (15/58, or 26%), followed by Pseudomonas species (8/58, or 14%), and Proteus species (8/58, or 14%). Adverse clinical experiences were few, and none was directly attributed to therapy with either antibiotic. The changes noted in the results of laboratory tests were considered to be unrelated to the antibiotics administered. Thus, both piperacillin and cefamandole were safe and effective in the treatment of patients with complicated urinary tract infections.

Disposition kinetics of cefamandole during continuous ambulatory peritoneal dialysis

Cefamandole disposition kinetics were examined in six male subjects with renal impairment who were undergoing continuous ambulatory peritoneal dialysis. Creatinine clearance values ranged from less than 1 to 11 ml/min. Cefamandole was given as a 1-g intravenous dose infused over 30 min. Cefamandole concentrations were determined in serum, urine, and dialysis fluid by a high-performance liquid chromatographic method. The following average parameter values were obtained (range): half-life, 6.1 h (4.6 to 9.7); systemic clearance, 21.9 ml/min (8.4 to 35.5); renal clearance, 11.5 ml/min (0.03 to 22.3); dialysis clearance, 0.92 ml/min (0.7 to 1.3); nonrenal clearance, 12.2 ml/min (2.9 to 27.0); volume of distribution, 0.18 liter/kg (0.09 to 0.25); steady-state volume of distribution, 0.17 liter/kg (0.09 to 0.24). Approximately 5% of the dose was dialyzed (range, 2.8 to 8.3), indicating that there is no need to supplement a dosing regimen of cefamandole due to loss by dialysis. There was a positive correlation between creatinine clearance and the terminal elimination rate constant of cefamandole (r2 = 0.41) and cefamandole renal clearance (r2 = 0.83).

Update on the treatment of bacterial urinary tract infections

The treatment of urinary tract infections (UTIs) has become a complex problem for the clinical practitioner. An understanding of the pharmacology, pharmacokinetics, and in vivo biological activity of antimicrobial agents is needed, as is an understanding of the variables that may influence patient compliance with medication regimens. Although UTIs are usually treated for 10 to 14 days, shorter treatment schedules of seven to ten days or even single-dose regimens are possible. Guidelines for the treatment of UTIs are presented along with suggestions for increased patient compliance.

Pharmacology, Safety, and efficacy of cefamandole in childhood infections

We used cefamandole in the initial treatment of 34 children (10 months to 15 years of age) with suspected bone, joint, or soft tissue infections. The minimal inhibitory concentration of organisms encountered ranged between 0.015 and 2 microgram/ml. At 1 h after intravenous infusion of 25 mg/kg, the mean serum level of cefamandole was 26.2 microgram/ml (range, 8.9 to 47.5 microgram/ml), and at 3 h the level was 1.8 microgram/ml (range, 0.6 to 4.4 microgram/ml), which is above the minimal inhibitory concentration for most of the organisms encountered. However, when the drug was given intravenously every 6 h, the mean level after a 37-mg/kg dose was 0.9 microgram/ml (range, less than 0.5 to 1.9 microgram/ml) at 4 h and, by extrapolation, would have fallen below 0.1 microgram/ml at 6 h. The mean serum half-life was 34 min. Cefamandole appeared to diffuse well into synovial fluid, with joint fluid levels between 5 and 40 microgram/ml. The drug was tolerated well. Cefamandole appears to be a reasonable alternative in the initial treatment of skeletal infections in children, but need to be administered every 4 h to maintain suprainhibitory serum levels between doses.

Pharmacokinetics and safety of cefamandole in infants and children

Cefamandole, a new cephalosporin antibiotic, has greater activity against common pathogens, including Escherichia coli, Haemophilus influenzae, and Proteus (including indole-positive strains), than available cephalosporin drugs. We have evaluated the safety and pharmacokinetics of this drug in 30 infants and children. Blood levels and urinary excretion of the drug were similar to those previously found in adults. The only side effects were mild and transient elevation of serum glutamic oxalacetic transaminase in 12 patients and of blood urea nitrogen in 1 patient in whom serum creatinine remained normal and unchanged.