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PubMedDate not supplied

Perioperative antibiotic prophylaxis in cardiovascular surgery: a prospective randomized comparative trial of cefazolin versus ceftriaxone.

With a view of possible reduction in antibiotic dosage, several prospective randomized comparative trials performed in our institution showed that a 4-day prophylactic antimicrobial regimen with cefazolin was equally effective as a 2-day prophylaxis with cefuroxime and that the best regimen was equally as effective as a double dose of ceftriaxone prophylaxis in major cardiovascular surgery. In this prospective randomized comparative study, 1-day cefazolin prophylaxis (4 X 0.5 g intravenously) was compared with a single dose of ceftriaxone prophylaxis (2 g intravenously). Of the 900 patients enrolled in the study, 17 were subsequently excluded. Of the remaining 883 patients, 439 were in the cefazolin group and 444 were in the ceftriaxone group. The overall postoperative infection rate was 5.0% in the cefazolin group and 4.5% in the ceftriaxone group. In view of the almost identical infection rates in both groups, we considered that a single 2 g dose of ceftriaxone offers patients a reliable antimicrobial prophylaxis. The single-dose prophylaxis has the additional advantage of reducing the dosage administered and the costs of administration.

Bacterial Infections↗
PubMedDate not supplied

Comparison of topical 0.3% ofloxacin to fortified tobramycin-cefazolin in the therapy of bacterial keratitis.

BACKGROUND: In this study we compared topical ofloxacin with a combination of fortified tobramycin sulphate and cefazolin sodium solutions in the treatment of culture-proved bacterial keratitis. METHODS: 30 eyes of culture-proved bacterial corneal ulcers of moderate severity were included in a prospective randomized, controlled, double-masked study for comparison. The cases were randomly allocated to treatment with 0.3% ofloxacin solution (Group I) and combination of fortified antibiotics (1.5% tobramycin and 5% cefazolin solutions--Group II as control) along with supportive cycloplegic, vitamins and antiglaucoma therapy. Time for healing of ulcer and subjective symptoms were main outcome measures. Student's t-test was used to compare the results. RESULTS: Staphylococcus aureus and coagulase-negative staphylococci were the two most common organisms isolated. Resolution of the ulcer was achieved in 93% and 87% in the treated and the control group, respectively. The mean duration of symptomatic relief was 7.8 +/- 1.54 days in the treated group and 8.33 +/- 1.44 days in the control group; for epithelial healing it was 15.0 +/- 3.86 days in the treated group and 15.46 +/- 3.86 days in the control group. Post resolution the best corrected visual acuity of 20/200 or better was achieved in all but one eye each in both groups. CONCLUSIONS: Both ofloxacin 0.3% and combined fortified tobramycin 1.5% and cefazolin 5% topical drops were comparable for treating cases of bacterial corneal ulcer of moderate severity. However, considering the easy availability and cost effectiveness of ofloxacin, a monotherapy with ofloxacin may be preferred over the combined, fortified tobramycin and cefazolin therapy.

Adolescent↗
PubMed1979

Prophylactic antibiotics in cesarean section: a double-blind study of cefazolin.

One hundred twenty-two patients were evaluated prospectively to determine the clinical efficacy of prophylactic cefazolin (Ancef) in cesarean section. The cefazolin was administered intravenously in a high-dose, short perioperative regimen. Postoperatively, each patient was evaluated for morbidity. Over all, the post operative morbidity rate was reduced from 30 per cent in the placebo group to 18 per cent in the cefazolin group. More important, the infection rate associated with primary cesarean section was significantly lessened from 38 per cent in the placebo group to 16 per cent in the drug group (p less than 0.025). In repeat cesarean sections, the postoperative morbidity rate was greater in the antibiotic-treated group (20 per cent) than in the placebo group (14 per cent). Of major importance, a predominant organism, Group D streptococcus, was encountered in the postoperative cultures of the cefazolin group.

Cefazolin↗
PubMed1984

Comparative cervical microflora shifts after cefoxitin or cefazolin prophylaxis against infection following cesarean section.

The aerobic and anaerobic cervical microflora was determined before operation and on day 4 after operation in groups of women undergoing a clinical trial of prophylaxis with three doses of cefoxitin, cefazolin, or placebo for infectious complications of nonelective cesarean section. Floral shifts occurred post partum, with return of Escherichia coli and Bacteroides fragilis and a decrease in Candida colonization. No significant differences in flora existed preoperatively among patients receiving cefoxitin, cefazolin, or placebo, but by day 4, both antibiotic groups had greater enterococcal colonization. This difference was more marked with cefoxitin than with cefazolin. No difference in E. coli or B. fragilis colonization was noted by day 4 in placebo and antibiotic groups. Resistance developing in isolates in the antibiotic groups was mainly a result of enterococcal colonization. Results of this study indicate that a three-dose cephalosporin prophylactic regimen resulted in a significant selection of resistant enterococcal colonization but there was no increase in nosocomial infection in the antibiotic groups compared to the placebo group. There did not appear to be significant differences in either species selection or antibiotic resistance of aerobic or anerobic microflora between the cefoxitin and cefazolin groups.

Bacteria, Aerobic↗
PubMed1995

Pyelonephritis in pregnancy: once-a-day ceftriaxone versus multiple doses of cefazolin. A randomized, double-blind trial.

OBJECTIVE: The purpose of this study was to compare the efficacy of a single daily dose of intravenous ceftriaxone with that of multiple-dose cefazolin in the treatment of acute pyelonephritis in pregnancy. STUDY DESIGN: This was a double-blind, randomized, clinical trial. Patients admitted to the hospital with the diagnosis of acute pyelonephritis in pregnancy were enrolled and randomized according to a computer-generated randomization schedule. The study group received a single daily 1 gm dose of ceftriaxone intravenously along with two additional doses of normal saline solution. The comparison group received three daily 2 gm doses of cefazolin intravenously. All infusions were given on an 8-hour schedule. Treatments were continued until the patient became afebrile. Each patient was discharged from the hospital on a regimen of appropriate oral antibiotics as directed by urine culture and sensitivities. At follow-up visits test-of-cure cultures were obtained. RESULTS: During the 2-year study period, 178 patients were randomized: 88 received cefazolin and 90 ceftriaxone. Patient demographics and presenting signs and symptoms were similar in both groups. No differences were noted between the groups regarding days of febrile morbidity, length of hospital stay, or treatment failures. CONCLUSIONS: Daily single-dose intravenous ceftriaxone is as effective as multiple-dose cefazolin in the treatment of patients with acute pyelonephritis during pregnancy.

Adult↗
PubMed1986

Anaerobic coverage for wound prophylaxis. Comparison of cefazolin and cefoxitin.

An experimental wound model has been used to evaluate the effectiveness of cefazolin and cefoxitin in the prevention of wound infection. Incisions were contaminated with Staph. aureus, E. coli, or a standardized fecal suspension. Regardless of the contaminant employed, the prophylactic use of either cefazolin or cefoxitin yielded lower wound bacterial concentrations and fewer infections compared with treatment with placebo. Cefazolin proved just as effective as cefoxitin in preventing infection when wounds were contaminated with Staph. aureus or E. coli. Although cefoxitin is the only cephalosporin that offers anaerobic coverage, its prophylactic administration when wounds were contaminated with a standardized fecal suspension did not significantly alter wound bacterial concentrations or infection rates compared with cefazolin. The data from our animal wound model suggest that prophylactic anaerobic coverage is not necessary.

Animals↗
PubMed1976

Cefazolin and cephalexin levels in prostatic tissue and sera.

A study was carried out on 18 patients given cefazolin intramuscularly and 17 patients given cephalexin by mouth preoperatively prior to transurethral resection of the prostate. Prostatic tissue and serum levels of the two drugs were determined and contrasted with previously reported mean inhibitory concentrations. It was found that cefazolin was present in the sera and prostatic tissues in levels greater than was cephalexin and that cefazolin frequently exceeded the minimum inhibitory concentrations necessary for sensitive organisms to be affected, whereas cephalexin did not. Therefore, it would appear that cefazolin would be preferable to cephalexin in treatment of acute bacterial prostatitis.

Biological Availability↗
PubMed1991

Antibiotic prophylaxis in non-cardiac thoracic surgery: cefazolin versus placebo.

A total of 127 patients (57 given placebo and 70 given a single preoperative dose of 1 g cefazolin) undergoing thoracic surgery were included in a randomized double-blind trial. The two groups were similar in regard to mean age, sex ratio, in-hospital stay before surgery, underlying disease, risk factors, type of surgery, mean duration of surgical procedure, and mean duration of chest tube drainage. The relative risk of wound infection of the patients from the placebo group was 3.27 (range 1.5-11.5; 95% confidence interval). Cefazolin significantly reduced (p less than 0.01) the wound infection rate--1 case (1.5%) in the cefazolin group versus 8 cases (14%) in the placebo group--but not the incidence of postoperative pleural empyema--5 (7%) versus 8 cases (14%)--or nosocomial pneumonia--3 (4%) versus 5 cases (9%). Cultures were made from 3 out of 9 wound infections and Staphylococcus aureus or S. epidermidis was isolated in all 3. In addition, cultures were made from 6 out of 13 pleural cavity infections and S. aureus (1 case) or other microorganisms (5 cases) were isolated in all 6. Mortality was similar in both groups and all deaths unrelated to the infections. No adverse side effects of the drug were encountered. In conclusion, a single preoperative dose of 1 g cefazolin proved to be effective for reducing the wound infection rate in non-cardiac thoracic surgery.

Adult↗
PubMedDate not supplied

Daptomycin cure after cefazolin treatment failure of Methicillin-sensitive Staphylococcus aureus (MSSA) tricuspid valve acute bacterial endocarditis from a peripherally inserted central catheter (PICC) line.

Right-sided acute bacterial endocarditis (ABE) is an infrequent complication of central intravenous (IV) lines. We report a case of methicillin-sensitive Staphylococcus aureus tricuspid valve (TV) ABE related to a peripherally inserted central catheter line (PICC). Patients with right-sided ABE present with symptoms of fever and chills, and symptoms and signs of pulmonary emboli. In the patient presented, the PICC line was removed and high-dose cefazolin therapy, 2 g (IV) every 8 hours, was initiated. Although the patient's blood cultures became negative during the third week of cefazolin therapy, her erythrocyte sedimentation rate and teichoic acid antibody titers remained high. Pulmonary emboli developed. A large TV vegetation (1 x 2 cm) remained unchanged after 4 weeks of cefazolin therapy. For these reasons, cefazolin treatment was considered a treatment failure. Therapy with daptomycin was initiated at a dose of 6 mg/kg (IV) every 24 hours. During daptomycin therapy, the patient's erythrocyte sedimentation rate and teichoic acid antibody titers gradually returned to normal. Repeat transthoracic echocardiograph revealed the TV vegetation was gone and the methicillin-sensitive Staphylococcus aureus ABE was cured with daptomycin. We conclude daptomycin is a rapidly bactericidal antistaphylococcal antibiotic reliably effective even when other usually effective antistaphylococcal antibiotics have failed.

Acute Disease↗
PubMed2005

Single-dose oral ciprofloxacin compared with single-dose intravenous cefazolin for prophylaxis in inguinal hernia repair: a controlled randomized clinical study.

The aim of this study was to compare the efficacy of single-dose intravenous cefazolin prophylaxis with single-dose oral ciprofloxacin prophylaxis in patients undergoing tension-free inguinal hernia repair with polypropylene mesh. In a prospective and randomized setting, 395 patients received either a single dose of 500 mg of ciprofloxacin orally, 1--2h before the operation, or a single dose of 1g cefazolin intravenously on induction of anaesthesia. The primary outcome was to determine the wound infection rate within one year. The overall infection among the entire study population was 2% (eight of 395) including 2% (four of 199) of those receiving intravenous cefazolin and 2% (four of 196) of those treated with oral ciprofloxacin. There was no statistically significant difference between groups (P=0.59). All the infections were superficial incisional surgical site infections, and none progressed to a deep infection. Escherichia coli was the most commonly isolated bacterium. None of the infected patients developed recurrence of hernia. The rate of recurrence was 1.3% (five of 395) at one year including 2% (four of 199) of those receiving cefazolin and 0.5% (one of 196) of those receiving ciprofloxacin. Oral ciprofloxacin prophylaxis was found to be an attractive option with its wide antibacterial spectrum, low cost and ease of administration in patients undergoing tension-free inguinal hernia repair with polypropylene mesh.

Administration, Oral↗
PubMed2000

The routine use of cefazolin in cesarean section.

OBJECTIVE: To determine the effectiveness and safety of the routine use of antibiotic prophylaxis in women undergoing cesarean section. METHOD: Four hundred and forty-one women undergoing cesarean sections were randomly assigned either to a single dose of 1 g intravenous cefazolin or placebo after clamping of the umbilical cord. The primary outcome was the development of post-operative febrile morbidity and the secondary outcomes were infection-related complications. RESULT: There were 211 emergency and 230 elective cesarean sections. In the emergency cesarean sections, 34 (30.6%) women developed post-operative febrile morbidity in the placebo group compared to 11 (11%) women in the cefazolin group. This was a statistically significant difference (P = 0.001). Similarly, there were statistically significant differences between the two groups in the development of wound infection (P<0.001), use of therapeutic antibiotics (P = 0.001), and post-operative days in hospital (P = 0.003). No statistically significant differences were detected in the development of other infection-related complications. In the elective cesarean sections, no statistically significant differences were found in post-operative febrile morbidity and infection-related complications. There were no serious side effects related to the use of cefazolin. CONCLUSION: The routine use of a single dose of cefazolin is safe and effective in emergency but not elective cesarean section.

Adult↗
PubMed1996

Comparison of ciprofloxacin ophthalmic solution 0.3% to fortified tobramycin-cefazolin in treating bacterial corneal ulcers. Ciprofloxacin Bacterial Keratitis Study Group.

PURPOSE: The purpose of the study is to compare the clinical efficacy and safety of ciprofloxacin ophthalmic solution 0.3% (Ciloxan) with a standard therapy regimen (fortified tobramycin, 1.3%-cefazolin, 5.0%) for treating bacterial corneal ulcers. METHODS: This randomized, parallel group, double-masked, multicenter study was conducted in 324 patients at 28 centers in the United States, Europe, and India. Patients were randomized into 2 treatment groups: 160 to ciprofloxacin and 164 to fortified tobramycin-cefazolin. Positive microbiologic cultures were obtained in 188 (58%) of 324 patients. Of these, 176 patients met protocol criteria and were evaluated for treatment efficacy: 82 in the ciprofloxacin group and 94 in the standard therapy group. The dosing schedule for both treatment groups was 1 to 2 drops of the first study medication (ciprofloxacin or fortified tobramycin) every 30 minutes for 6 hours, then hourly for the remainder of day 1; 1 to 2 drops every hour on days 2 and 3; 1 to 2 drops every 2 hours on days 4 and 5, followed by 1 to 2 drops every 4 hours on days 6 to 14. The second medication (ciprofloxacin or cefazolin) was instilled 5 to 15 minutes after the first drug, following the same dosing frequency. Physician's judgment of clinical success, cure rate, changes in ocular sings, and symptoms and the rate of treatment failures were the primary efficacy criteria. RESULTS: Topical ciprofloxacin monotherapy is equivalent clinically and statistically to the standard therapy regimen of fortified antibiotics. No statistically significant treatment differences were found between ciprofloxacin (91.5%) and standard therapy (86.2%) in terms of overall clinical efficacy (P = 0.34). Similarly, no differences were noted in resolution of the clinical signs and symptoms (P > 0.08) or the time to cure (P = 0.55). The incidence of treatment failures was less in the ciprofloxacin group (8.5%) compared with the standard therapy group (13.8%). Significantly fewer patients treated with ciprofloxacin reported discomfort than did patients treated with the standard therapy regimen (P = 0.01). CONCLUSION: Ciprofloxacin ophthalmic solution 0.3% monotherapy is equivalent clinically and statistically to standard therapy (fortified tobramycin-cefazolin) for the treatment of bacterial corneal ulcers and produces significantly less discomfort.

Adolescent↗
PubMed2003

Efficacy of a single dose of cefazolin as a prophylactic antibiotic in primary arthroplasty.

We analyzed the wound infection rate of 1,367 primary total hip and knee arthroplasties performed between 1991 and 1999. Two hundred and fifteen arthroplasties were performed with 3 doses (3 x 750 mg) of cefuroxime, and 1,152 arthroplasties were performed with a single preoperative dose (1 x 1 g) of cefazolin as antimicrobial prophylaxis. All wound infections that occurred within 2 years of the index surgery were analyzed. The deep wound infection rate of total hip arthroplasty was 1.1% (95% confidence interval [CI], 0%-3.3%) in the cefuroxime group and 1.1% (95% CI, 0%-2.2%) in the cefazolin group (Fisher's exact test, P = 1.0). The deep wound infection rate of total knee arthroplasty in the cefuroxime group (1.6%; 95% CI, 0%-3.8%) was not significantly different from the cefazolin group (1.0%; 95% CI, 0.3%-1.7%) (Fisher's exact test, P =.63). We concluded that a single dose (1 g) of cefazolin given at anesthetic induction offered similar protection to 3 doses (3 x 750 mg) of cefuroxime in preventing infection in primary total joint arthroplasty.

Aged↗
PubMed1989

Prediction of the distribution volumes of cefazolin and tobramycin in obese children based on physiological pharmacokinetic concepts.

So as to estimate the appropriate dose of antibacterial drugs in obese children, prediction of the volume of distribution in these children was attempted based on physiological pharmacokinetic concepts which had been constructed from results in normal-weight children. Serum concentration-time data after intravenous drip infusions of tobramycin and cefazolin were analyzed using noncompartmental analysis of obese children in whom the degree of obesity ranged from 30 to 80%. Volume of distribution at steady state (Vss) per total body weight of tobramycin was significantly less than that for normal-weight children (P less than 0.05), whereas the value of cefazolin was almost equal to that for normal-weight children. The equation to express the difference of Vss between cefazolin and tobramycin obtained in normal-weight children failed in obese children, suggesting that there is a large decrease in the extracellular space in obese children exceeding the interindividual variations in normal-weight children. The Vss value (liter) for tobramycin was predicted by using the equation 0.261 . (ideal body weight (kg) + 0.4 . [total body weight (kg) - ideal body weight (kg)]). The Vss value of cefazolin was predicted to be 0.3 . (predicted Vss of tobramycin) + 0.052 . total body weight (kg). A good correlation between the predicted and the observed Vss values was obtained.

Blood Proteins↗
PubMed2003

Complete recovery from prolonged cardio-pulmonary resuscitation following anaphylactic reaction to readministered intravenous cefazolin.

We describe a patient who developed a type I anaphylactic reaction to intravenous cefazolin. The patient had no known drug allergies and had previously received intraoperative intravenous cefazolin 2 months prior without any problems. Forty-fives after receiving cefazolin 1 g i.v. and while fully awake, the patient experienced shortness of breath, became unconscious, and then suffered a cardiac arrest. Resuscitation included endotracheal intubation, external cardiac compression, electrical defibrillation and multiple large doses of epinephrine, atropine, and sodium bicarbonate over the course of 2.5 h and three cardiac arrests. Nevertheless, the patient fully recovered. The intent of this case report is to address widely held concerns regarding cross-reactivity of cephalosporin, particularly cefazolin, to penicillin, the legitimacy of test dosing as a means to safely identify patients who will have an allergic reaction to cephalosporins and comment on patient-related predictors of survival following cardiopulmonary resuscitation and the good outcome in this case.

Adult↗
PubMed2001

Initial treatment of peritoneal dialysis peritonitis without vancomycin with a once-daily cefazolin-based regimen.

To reduce the use of vancomycin, the current recommendations of the International Society of Peritoneal Dialysis (PD) for the initial treatment of peritonitis complicating PD are to administer intraperitoneal (IP) cefazolin or cephalothin in every PD fluid bag, together with once-daily gentamicin. In view of the inherent impracticalities of this regimen, we studied the efficacy of once-daily cefazolin (1.5 g) IP with gentamicin IP as initial treatment for primary (nonrecurrent) PD peritonitis. This regimen has been used in all episodes of peritonitis not associated with tunnel or exit-site infections or fluid leaks. Sixty-nine episodes in 61 patients were analyzed (44 patients, continuous ambulatory PD; 22 patients, automated PD; and 3 patients, hospital-based intermittent PD), of which 38 episodes (55%) were gram-positive infections, 6 episodes (9%) were gram-negative infections, and 18 episodes (26%) had negative culture results. Four patients died within 4 weeks of infection (none considered attributable to inadequate treatment of their peritonitis). Ten catheters (14.5%) required removal to clear the infection; 7 catheters were in patients with gram-negative infections. The relapse rate within 4 weeks of ceasing antibiotic therapy was 8.9%. Compared with the results of 40 episodes of peritonitis treated initially with our previous IP vancomycin and gentamicin regimen, successful treatment (no death, catheter removal, or recurrence) was achieved in 52 of 69 episodes in the cefazolin group (75.4%) versus 23 of 40 episodes in the vancomycin group (57.5%; P: = 0.058). In conclusion, once-daily IP cefazolin and gentamicin for the initial treatment of PD peritonitis is at least as effective as a vancomycin-based regimen and is well tolerated.

Adult↗
PubMed2005

Effectiveness of topical taurolidine versus ciprofloxacin, ofloxacin, and fortified cefazolin in a rabbit Staphylococcus aureus keratitis model.

PURPOSE: Taurolidine is a broad-spectrum, non antibiotic antimicrobial agent, not previously tested against the common causes of bacterial keratitis. This study, employing an experimental rabbit model of Staphylococcus aureus keratitis, investigated the effectiveness of topical taurolidine in reducing the number of bacteria, and its effectiveness was compared with topical ciprofloxacin, ofloxacin, and 5% cefazolin. METHODS: The right corneas of all rabbits were intrastromally injected with 100 colony-forming units of Staphylococcus aureus ATCC strain 25923. The animals were divided into the following seven groups: Group 1 (6 rabbits) received taurolidine, group 2 (6 rabbits) received ciprofloxacin, group 3 (6 rabbits) received ofloxacin, group 4 (6 rabbits)received cefazolin, group 5 (5 rabbits) received polyvinylpyrrolidone (vehicle),group 6 (4 rabbits) received sterile water, and group 7 (4 rabbits) was left un-treated (control group). The eyes were topically treated every 30 min with the above-mentioned substances from 4 to 9 h postinjection. One hour after the last drop administration (at 10 h postinjection), signs of inflammation were scored in a masked fashion by slit-lamp examination. Then, their corneas were processed. The number of colony-forming units (cfu) per cornea in all eyes was also determined. RESULTS: All antimicrobial (taurolidine, ciprofloxacin, ofloxacin, and cefazolin) treatments significantly reduced cfu numbers and slit-lamp examination scores compared with untreated eyes, eyes that received the vehicle, or eyes with sterile water (all p values <0.05). Regarding cfu numbers, although taurolidine therapy was significantly less effective than ciprofloxacin or ofloxacin,there was no significant difference between taurolidine and cefazolin groups.However, taurolidine had similar clinical examination scores with the other antimicrobials, while it had lower scores than the vehicle, sterile water, or un-treated eyes. CONCLUSIONS: The results obtained in this study suggest that topicaltaurolidine is an effective, novel ocular chemotherapeutic agent for the therapy of rabbit experimental Staphylococcus aureus keratitis. This drug may be a useful and promising ocular antimicrobial.

Administration, Topical↗
PubMed1985

Reliability of cefaclor, cefazolin, cefamandole, and cephalothin disks to predict susceptibility of Enterobacteriaceae, Staphylococcus species, and Haemophilus influenzae.

Interpretive zone-size standards currently used for cephalothin and cefamandole disk tests also may be applied to tests with disks containing 30 micrograms of cefaclor or cefazolin. Against 627 representative isolates, susceptibility to cefaclor and cefazolin could be predicted by testing cephalothin. However, cefazolin is more active than cephalothin against isolates of Escherichia coli with a TEM beta-lactamase plasmid. The expanded spectrum of cefamandole continues to necessitate separate testing. Against methicillin-resistant staphylococci, cefaclor disks were more reliable than cephalothin or cefamandole, but false-susceptible results were seen with all four disks. For testing Haemophilus influenzae, the cefazolin disks were not reliable; cephalothin or cefaclor disks could predict susceptibility to either drug.

Cefaclor↗