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PubMed1984

A single preoperative dose of cefazolin prevents postoperative sepsis in high-risk biliary surgery.

To test the ability of cefazolin, given in a single dose preoperatively, to prevent infection in high-risk patients after biliary tract surgery, the authors conducted a double-blind, prospective, randomized, controlled study. Of 92 patients operated on for acute cholecystitis or bile-duct disease, 46 were given 2 g of cefazolin intravenously before operation. Bile was contaminated with bacteria in 36% to 50% of patients with acute cholecystitis, obstructive jaundice, bile-duct disease without jaundice, or over 50 years old compared with only 5% of patients with chronic cholecystitis or under 50 years of age. Postoperative sepsis was eight times more frequent in patients with contaminated bile than in those without. Only 1 patient who received cefazolin had a wound infection, but 9 of the 46 patients in the control group did. The bacteria causing wound sepsis were similar to those in the contaminated bile. The authors conclude that a single dose of cefazolin given intravenously before operation provides effective prophylaxis against infection in high-risk biliary tract surgery.

Abdomen↗
PubMed1981

Prophylactic cefazolin in gastric bypass surgery.

Because surgery in obese patients is associated with a high risk of infection, gastric bypass procedures offer an excellent opportunity to test the efficacy of prophylactic antibiotics. Accordingly, a double-blind prospective trial of prophylactic cefazolin was carried out in 53 consecutive patients who underwent gastric bypass surgery for morbid obesity. The patients were randomized to two treatment arms: (1) cefazolin intravenously, 1 gm 2 hours prior to surgery, at induction of anesthesia, and then 0.5 gm every 6 hours for 48 hours, or (2) an indistinguishable placebo of 5% dextrose at identical intervals. Serial cultures were taken at operation and in the postoperative period. Antibiotic levels of fat were measured by tissue extraction and B. subtilis assay. After surgery, patients were monitored for infection by clinicians unaware of their random assignment group. The study was terminated and the code broken when it was evident that wound infections were increased to a statistically significant difference in one arm of the study. The brief perioperative administration of cefazolin reduced the incidence of wound infection from 21% to 4% (P less than 0.05) and the incidence of urinary tract and pulmonary infections from 17% to 0% (P less than 0.05). Tissue levels of antibiotics confirmed adequate dosages in the test subjects. The advantages of prophylactic administration of cefazolin for gastric bypass procedures are clearly demonstrated in this study. This confirms other reports which have shown prophylactic antibiotics to be useful in a variety of procedures. These studies suggest the need to reconsider the traditional opposition to prophylactic antibiotics and to determine whether perioperative antibiotics should be used routinely in all major operations.

Adult↗
PubMed1995

A double-blinded, randomized, controlled clinical trial to compare cefazolin and cefonicid for antimicrobial prophylaxis in clean orthopedic surgery.

A double-blind, prospective randomized study was performed to compare cefazolin and cefonicid given for prophylaxis to 102 patients undergoing orthopedic surgery. Risk factors (e.g., age, sex, type of operation performed) among the two groups were similar. All patients had foreign material (prosthesis or other hardware) inserted at operation. There was a total of 6 infections (3 wound and 3 urinary tract) in 6 patients among the 48 receiving cefazolin (12.5%), whereas no infections were observed among the 54 patients who received cefonicid. Cefonicid, given once daily, provides protection against postoperative infection that is not inferior to cefazolin. A larger study is needed to confirm whether cefonicid is indeed superior to cefazolin.

Adolescent↗
PubMed1976

Double-blind comparison of phlebitis associated with cefazolin and cephalothin.

In a double-blind, crossover study in 28 patients having infections susceptible to cephalosporins (mostly Staphylococcus or Streptococcus), phlebitis developed in twice as many patients (46.4%) receiving intravenous cephalothin within 48 hours, as in patients (21.4%) receiving intravenous cefazolin over the same time period. Likewise, drug therapy had to be discontinued more frequently with cephalothin (39%) than with cefazolin (21%), and the percentage of patients reporting pain or discomfort scores of 1+ or higher was greater with cephalothin (46.4%) than with cefazolin (21.4%). In our study, the intravenous administration of cefazolin was associated with a lower incidence of phlebitis than was cephalothin.

Adult↗
PubMed1994

Is monotherapy with cefazolin or ofloxacin an adequate treatment for peritonitis in CAPD patients?

This prospective randomized study is an evaluation of efficacy of cefazolin and ofloxacin in 23 end-stage renal disease (ESRD) patients treated with continuous ambulatory peritoneal dialysis (CAPD) who experienced 38 episodes of peritonitis (P). Cefazolin was administered intraperitoneally: 1000 mg as loading dose and 250 mg every exchange as maintenance dose for ten days. Ofloxacin was given orally: first 300 mg, followed by ten daily doses of 200 mg. Microbes most frequently isolated from peritoneal effluent were Staphylococci (coagulase-negative in 55.3%, aureus in 7.9%), Acinetobacter (in 5.3%), Klebsiella (in 5.5%), and Micrococcus (in 5.3%). Used as monotherapy, we found the efficacy of both cefazolin and ofloxacin inadequate for treatment of P in CAPD patients (cefazolin 65%, ofloxacin 67%) (NS).

Adult↗
PubMed1994

Single-dose cefuroxime versus multiple-dose cefazolin as prophylactic therapy for high-risk cholecystectomy.

The ideal regimen for the prevention of postoperative infections occurring after elective cholecystectomy has been widely debated. This double-blind, randomized study was conducted to compare the effectiveness and safety of cefuroxime with that of cefazolin in 295 patients undergoing elective cholecystectomy who were considered to be at high risk for postoperative infection. Patients were randomly assigned to receive either a single 1.5 gram dose of cefuroxime plus three doses of placebo, or four 1 gram doses of cefazolin. Each regimen was begun 30 to 60 minutes preoperatively and repeated every six hours for three doses postoperatively. Patients were evaluated during the hospitalization period and again at 30 days. All postoperative infections, including remote infections, were included in the definition of failure. Bacteriologic success rates were 95.5 percent in the cefuroxime group and 98.2 percent in the cefazolin group (p > 0.05). Corresponding clinical success rates were 91.4 and 94.9 percent (p > 0.05), respectively. There was no association between intraoperative bile cultures and the risk of failure or the type of microorganism isolated from postoperative infections. Both regimens were well-tolerated. In view of the additional costs and time associated with preparation and administration of multiple doses, a single preoperative 1.5 gram dose of cefuroxime may be a cost-effective alternative to four 1 gram doses of cefazolin in patients undergoing elective cholecystectomy who are at high risk for postoperative infection.

Cefazolin↗
PubMed1977

[Cefazolin content in the gall bladder (author's transl)].

The concentration of cefazolin in the bile obtained by means of duodenoscopy was determined and compared with the values published as results of sampling by gall bladder puncture and T drains. The results obtained using this endoscopic procedure accorded with the results in the literature. When 1 g cefazolin was administered intravenously, high biliary levels of this drug with antibacterial activity were achieved. Our preliminary studies show that not only highly-sensitive gram-positive organisms, but also most of the E. coli Klebsiella and indol-negative proteus bacteria were affected when 1 g cefazolin was administered 3-4 times daily. These results will be reported later. Cefazolin (Gramaxin) represents a valuable addition to the chemotherapeutic agents available in combating infections of the gall bladder and the biliary duct system.

Bacterial Infections↗
PubMed1987

Antimicrobial susceptibility of bacteria isolated in 1985--with special reference to prevalence of methicillin-resistant staphylococcus aureus and activities of cefazolin, cefotaxime and piperacillin.

Antimicrobial susceptibility of nine species and one group of bacteria isolated from patients at the hospitals of Seoul National University, Severance, Hanyang University, and Kyungpuk University were tested by agar dilution method. S. aureus was most susceptible to cefazolin, methicillin and cotrimoxazole, and enterococci to ampicillin. Isolates of Enterobacteriaceae were most frequently susceptible to aminoglycosides and cefotaxime. Cefazolin susceptibility was markedly different from species to species. Aminoglycosides and piperacillin were more active than others against P. aeruginosa, and amikachin against A. anitratus. A large proportion of strains of several different species were conditionally susceptible to either tetracycline, ampicillin, cefazolin or cotrimoxazole suggesting the usefulness of these drugs for treatment of urinary tract infection. Activity of cefotaxime was highest against E. coli, and K. pneumoniae, while lowest against A. anitratus and P. aeruginosa. Decrease in the proportion of susceptible isolate was noted in E. coli and K. pneumoniae to cefazolin, K. pneumoniae, E. cloacae and S. marcescens to cotrimoxazole, and P. aeruginosa to tobramycin and gentamicin.

Anti-Bacterial Agents↗
PubMed2004

Intrathecal cefazolin-induced seizures following attempted discography.

This report describes a 39 year-old woman who underwent attempted discography and intradiscal electrothermal therapy (IDET) of the L5/S1 intervertebral disc. The procedure was abandoned after multiple unsuccessful attempts to cannulate the disc. The case was complicated by at least two lumbar dural punctures, confirmed by injection of nonionic contrast that contained 12.5 mg/mL of cefazolin, included for prophylaxis of discitis. About 45 minutes later the patient developed severe back pain. Shortly thereafter she became progressively agitated and confused, and developed intractable seizures and coma. Despite aggressive treatment the patient could not be resuscitated and expired several hours later. Convulsions were initially attributed to an adverse reaction to meperidine and promethazine, given for the back pain, however this explanation proved to be untenable. In addition, the accidental administration of an ionic contrast agent, such as Hypaque(R), was excluded. Based on a detailed review of the case and the literature, it was concluded that the patient succumbed from an unintentional dose of intrathecal cefazolin, which had been diluted in the nonionic contrast agent that was used to confirm needle placement. Available evidence indicates that cefazolin is a potent epileptogenic agent when given intrathecally. The facts of the case and the evidence supporting the conclusion are presented. It is recommended that cefazolin not be mixed with the contrast agent used to document initial needle placement during discography.

Journal Article↗
PubMed1995

Efficacy of ofloxacin vs cefazolin and tobramycin in the therapy for bacterial keratitis. Report from the Bacterial Keratitis Study Research Group.

PURPOSE: To compare ofloxacin solution with a combination of fortified antibiotic cefazolin sodium and tobramycin sulfate solutions in the treatment of bacterial keratitis. METHODS: Patients under care at any one of 28 participating clinical centers who had an eye with suspected bacterial keratitis were randomly allocated in a double-masked manner to treatment with 0.3% ofloxacin solution or a combination of the fortified antibiotics (1.5% tobramycin and 10.0% cefazolin solutions). MAIN OUTCOME MEASURES: Time to healing defined as complete re-epithelization, accompanied by a nonprogressive stromal infiltrate for two consecutive visits. Secondary outcome measures included patient symptoms and signs of infection and adverse reactions to study medications. Only patients with a positive bacterial corneal culture were included in most analyses. RESULTS: A positive bacterial corneal culture was obtained in 140 (56%) of the 248 enrolled patients. The time to healing was similar among the 73 patients receiving ofloxacin and the 67 patients receiving fortified antibiotics (P = .70). By 7 days after study entry, the keratitis in 37% of the ofloxacin group and 38% of the fortified antibiotics group had healed. By 28 days, keratitis in 89% of the ofloxacin group and 86% of the fortified antibiotics group had healed. Two patients receiving ofloxacin and one receiving fortified antibiotics discontinued study medication because of lack of efficacy. Patients receiving ofloxacin reported substantially less burning and stinging on instillation than the patients receiving fortified antibiotics (P < .001). Five of six patients among the 140 with positive bacterial cultures who had study medications discontinued because of ocular side effects were in the fortified antibiotics group; an additional three patients, all in the fortified antibiotics group, among the remaining 108 receiving study medications had ocular side effects. CONCLUSIONS: The efficacy of ofloxacin solution in treating bacterial keratitis is equivalent to that of the fortified cefazolin and tobramycin solutions. The reduced frequency of ocular toxic effects and the relative ease of preparation of ofloxacin are additional considerations.

Adult↗
PubMed1987

Single-dose antibiotic prophylaxis for biliary surgery. Cefazolin vs moxalactam.

Cefazolin was compared with moxalactam for single-dose prophylaxis against infection in a double-blind, prospective, randomized trial of 90 patients undergoing cholecystectomy. Risk factors for infection were present in 65 (72%) of the 90 patients and were evenly distributed. Antibiotic levels in plasma, bile, and tissue measured when the cystic duct was divided were similar for both drugs. Age greater than 65 years but not recent cholecystitis or type of antibiotic was predictive of recovery of bacteria from bile cultures. Wound infections occurred in two patients receiving cefazolin and one patient receiving moxalactam for an overall infection rate of 3%. No toxic reactions to antibiotics, including bleeding disorders, were observed. In conclusion, no significant difference in prophylactic efficacy was detected in this comparison of a first-generation with a third-generation cephalosporin. Because of its lower cost and narrower antimicrobial spectrum, however, cefazolin should remain the agent of choice.

Adult↗
PubMed1991

Pharmacokinetics of cefazolin applied topically to the surgical wound.

Topical application of antibiotics is used in the prophylaxis of postoperative surgical infections. However, whether topically applied antibiotics remain primarily in the surgical wound fluid or are systemically absorbed is uncertain. The pharmacokinetics of topically applied cefazolin were studied in a canine model that allowed simultaneous determination of serum and wound fluid antibiotic concentrations. Topical administration of cefazolin resulted in high antibiotic concentrations in the wound fluid for prolonged periods and rapid systemic absorption. Bioavailability after topical administration was 95%. Within 1 hour, the serum concentrations after topical administration equaled the serum concentrations after intravenous administration, and the concentration time curves declined in parallel. In wound fluid, the mean time above the susceptibility break point minimum inhibitory concentration after topical administration of cefazolin was 5.76 hours compared with the estimated time above the minimum inhibitory concentration of 2.55 hours after intravenous administration.

Animals↗
PubMed1984

Nonaqueous cephalosporin suspension for parenteral administration: cefazolin sodium.

The flocculation-deflocculation behavior of cefazolin sodium (I) in nonaqueous media and the effect of surfactants as measured by zeta potential, sedimentation, and porosity were studied. A significant difference in zeta potential was observed when the particles were suspended in different nonaqueous media. The addition of surfactant produced a deflocculated state. The surfactant deflocculated the particles by a process of supersaturation and crystallization involving a surfactant-cefazolin complex. The shielding effect of the surfactant on the surface of the particles also apparently affected their electrophoretic properties. Kinetic studies on the stability of the drug as a function of temperature were conducted; it appears that the chemical stability in ethyl oleate at room temperature is adequate for a reasonable shelf life. The efficiency of absorption of the drug from the ethyl oleate suspension was evaluated after intramuscular administration in dogs. The area under the plasma concentration versus time curve and urinary recovery indicated that cefazolin was 100% bioavailable from this nonaqueous preparation.

Absorption↗
PubMed1996

[Peritoneal and subcutaneous administration of cefazolin as perioperative antibiotic prophylaxis in colorectal operations. Prospective randomized comparative study of 200 patients].

The prophylactic effect of a intraoperative intraperitoneal and subcutaneous application of cefazolin versus a single shot i.v. prophylaxis was investigated. Additionally, we registered the concentration of cefazolin in the serum and the peritoneal fluid in 22 patients. We randomized 200 patients of whom 189 were included in the study. Ninety-two patients received the prophylaxis i.v. (group 1) and 97 topically (group 2). In 4 (2.1%) wound infections occurred [3(3.3%) group 1 and 1 (1.0%) in group 2]. The difference was not significant. The concentration of cefazolin in the serum was significantly higher at 1 h and 2 h postoperatively in group 2. We conclude that a topical application of antibiotics is possible to prevent surgical wound infection.

Aged↗
PubMed1976

Concentrations of cefazolin in human skeletal muscle.

Tissue concentrations of cefazolin were measured in 18 patients undergoing urological operations. Specimens of skeletal muscle and blood were taken simultaneously at predetermined intervals. The concentrations in serum and homogenized skeletal muscle were determined by means of the agar well diffusion method. A comparison of standard curves obtained with phosphate buffer solution and the supernatant of muscle homogenate revealed no substantial binding of cefazolin to the supernatant of muscle homogenate. Because of methodological difficulties in determining the different compartments of a tissue specimen concentrations in tissue were not corrected. Within two hours after a short infusion (25 min.) of 2 g of Cefazolin in muscle tissue a peak concentration of 20 mug/g was reached. A tissue level above 10 mug/g maintained for three hours. This concentration is high enough to inhibit nearly all strains of E. coli, Klebsiella, Salmonella, Shigella and a large part of Proteus mirabilis, whereas nearly all gram-positive bacteria are inhibited at a lower concentration.

Bacteria↗
PubMedDate not supplied

Ceftriaxone versus aztreonam plus cefazolin for infections in cancer patients with adequate neutrophil counts.

In a prospective randomized trial, 154 febrile episodes in cancer patients with adequate neutrophil counts (greater than 1,000 cells/mm3) were treated with either ceftriaxone (72 episodes) or aztreonam plus cefazolin (82 episodes). Documented infections represented almost half of the febrile episodes. The overall response rates among the 144 evaluable episodes were similar for the two regimens: 76% (51/67) with ceftriaxone versus 82% (63/77) with aztreonam plus cefazolin (p = 0.41, not significant). Although not statistically significant, the response rate of the microbiologically documented infections was slightly better in patients treated with the double beta-lactam combination (85% vs. 65%, p = 0.16) and clinically documented infections showed a better response in the group of patients receiving monotherapy (87% vs. 59%, p = 0.12). No serious adverse effects were observed during this study and both regimens were well tolerated. Ceftriaxone or the combination of aztreonam plus cefazolin showed a similar efficacy as empirical therapy for infections in cancer patients with adequate neutrophil counts.

Adolescent↗
PubMed2005

Therapy with gentamicin-PMMA beads, gentamicin-collagen sponge, and cefazolin for experimental osteomyelitis due to Staphylococcus aureus in rats.

INTRODUCTION: In spite of new surgical techniques and recently developed antibiotics, there is no satisfactory solution for the treatment of chronic posttraumatic osteomyelitis. The introduction of local antibiotic treatment with gentamicin-PMMA beads according to Klemm has provided new stimuli for the treatment of chronic osteomyelitis. With the development of collagen as an absorbable carrier substance, the disadvantages of the rigid carrier system became evident. Due to the varying surgical techniques and different forms of adjuvant therapy, it is difficult to assess therapeutic methods and compare different studies. Therefore, it seemed appropriate to study the effect of local treatment with different antibiotic carriers in the setting of an animal study. MATERIALS AND METHODS: The proven rat model for Staphylococcus aureus-induced osteomyelitis was used to compare the results of monotherapy with cefazolin, gentamicin-PMMA beads, or gentamicin-containing collagen sponge with the combination of local and systemic antibiotic treatment. RESULTS: Single-agent therapy with parenterally administered cefazolin reduced the CFU from 3.7 x 10(6) to 2.9 x 10(4) g(-1) of tibial bone. The effect on osteomyelitis was more pronounced with the local application of antibiotics. The best results were achieved with the gentamicin-containing collagen sponge which reduced the bacterial colony count to 1.4 x 10(2) CFU/g compared with 9.8 x 10(2) CFU/g achieved with gentamicin-PMMA beads. The effect was most marked using a 4-week combination therapy with local application of the gentamicin-containing collagen sponge and systemic administration of cefazolin. In 9 of 11 animals, no bacteria could be detected in the bone. CONCLUSION: Each of the treatment modalities resulted in a significant therapeutic effect. Due to its ability to quickly release large amounts of gentamicin, the flexible gentamicin-containing collagen sponge proved to be superior to the rigid PMMA system. Although the gentamicin-containing collagen sponge provided high antibiotic concentration at the site of implantation, an additive effect was attained when combined with systemic antibiotic treatment.

Animals↗
PubMed2006

Infection management in a patient with a left ventricular assist device: a case report of long-term cefazolin sodium hydrate administration.

A 55-year-old woman suffered from a bloodstream infection (Staphylococcus aureus), which originated from pump inflow and outflow skin exits, from 4 months after a parocorporeal left ventricular assist device (LVAD) had been implanted. In addition to local irrigation, repeated administration of a weekly unit of cefazolin hydrate was temporarily effective, but fever frequently recurred. Because short-term antibiotic administration had limited effectiveness, a much longer-term course of cefazolin was begun at 14 months post-LVAD implantation and was planned to continue until future transplantation. Unfortunately, the patient died from a cerebral embolism at 19 months after LVAD implantation; long-term consecutive cefazolin administration had suppressed the infection for over 5 months without side effects. To treat intractable LVAD-associated bloodstream infection, long-term administration of a narrow-spectrum beta-lactam drug is an effective option.

Anti-Bacterial Agents↗