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PubMed2004

Cefazolin tolerance does not predict ceftriaxone hypersensitivity: unique side chains precipitate anaphylaxis.

A 48-year-old woman with a questionable history of an unspecified ceftriaxone allergy was treated with cefazolin for surgical antibiotic prophylaxis. After she tolerated cefazolin therapy for 4 days, the medical staff concluded that her allergy history was inaccurate, and she was treated with intravenous ceftriaxone for suspected nosocomial pneumonia. Approximately 10 minutes after the start of the infusion, the patient experienced anaphylaxis. Initial symptoms of oral angioedema and laryngopharyngeal constriction progressed to dyspnea, tachypnea, hypotension, and tachycardia, all of which quickly resolved after immediate treatment with hydrocortisone, diphenhydramine, and epinephrine. Skin testing with cefazolin, cefepime, and ceftriaxone revealed that the likely allergic determinant mediating the patient's hypersensitivity reaction was the unique ceftriaxone R2 side chain and not the beta-lactam ring, which initially was suspected by the physician. Immunoglobulin E-mediated hypersensitivity reactions to cephalosporins may occur due to antibody complexes with the beta-lactam ring or various cephalosporin side chains. Misconceptions regarding the nature of cephalosporin allergies complicate antibiotic selection for patients with questionable allergy histories and may lead to inappropriate drug reexposure and anaphylaxis. Detailed understanding of the antigenic determinants that mediate hypersensitivity reactions is essential for clinicians to avoid type 1 reactions in patients with a suspected allergy to cephalosporins.

Anaphylaxis↗
PubMed1992

Methicillin-resistant Staphylococcus aureus keratitis in the rabbit: therapy with ciprofloxacin, vancomycin and cefazolin.

To determine the efficacy of a fluoroquinolone antibiotic in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) keratitis, topical administration of 0.3% ciprofloxacin was compared with topical 5.0% vancomycin or 5.0% cefazolin in experimental infections in the rabbit eye. The infections were established by intrastromal injection of 100 colony forming units (CFU) of MRSA, which resulted in greater than 10(6) CFU per cornea by 12 hr postinfection. Chemotherapy (one drop every 15 min) was given from 4-9, 10-15, or 10-20 hr postinfection. Early therapy (4-9 hr postinfection) with ciprofloxacin rendered all eyes free of bacteria; ciprofloxacin was significantly more effective than vancomycin or cefazolin. When treatment was initiated 6 hr later (10-15 hr postinfection), no corneas became free of bacteria, but ciprofloxacin was again more effective than vancomycin or cefazolin. Bacterial killing by ciprofloxacin after treatment from 10-20 hr postinfection was also significantly greater than that of vancomycin. Overall, the results show that ciprofloxacin is effective in killing methicillin-resistant staphylococcus aureus, and is most effective when applied during the very early stages of infection.

Animals↗
PubMed1987

Contribution of clinical pharmacists to cefazolin utilization.

Cefazolin utilization guidelines were established by representatives of major participants in the patient care process in a 520-bed teaching hospital. Patients admitted to certain hospital units and placed on cefazolin therapy were concurrently monitored for compliance with guidelines by clinical pharmacists (experimental group), while patients admitted to similar units were not monitored for guideline compliance (control group). When therapy, in the experimental group, was deemed noncompliant to the established guidelines, the pharmacist alerted the physician and made recommendations to correct the deficiency. The percent increase in compliance with guidelines attributed to clinical pharmacist intervention was then measured. Clinical pharmacy monitoring for the experimental group increased the rate of compliance with guidelines and decreased the overall cost of patient care. The projected net annual savings in cefazolin cost was calculated to be $7,913.00.

Anti-Bacterial Agents↗
PubMed2000

[The effect of cefazolin loaded bone matrix gelatin on repairing large segmental bone defects and preventing infection after operation].

OBJECTIVE: To explore the possibility of repair long segmental bone defects and preventing infection with cefazolin loaded bone matrix gelatin (C-BMG). METHODS: C-BMG was made from putting cefazolin into BMG by vacuum adsorption and freeze-drying techniques. The sustaining period of effective drug concentration in vitro and in vivo was detected by inhabition bacteria, and the drug concentration in local tissues (bone and muscle) and plasma after implantation of C-BMG was examined by high performance liquid chromatography(HPLC). RESULTS: The effective inhibition time to staphylococcus aureus of C-BMG was 22 days in vitro, while 14 days in vivo. The drug concentration in local tissues(bone and muscle) were higher than that of plasma, and the drug concentration in local tissues was higher in early stage, later it kept stable low drug release. It suggested that C-BMG had excellent ability to repair segmental long bone defects. CONCLUSION: C-BMG can gradually release cefazolin with effective drug concentration and has excellent ability to repair segmental long bone defects. It may be a novel method to repair segmental long bone defects and prevent infection after the operation.

Animals↗
PubMed1992

Allergy to cefazolin: study of in vivo cross reactivity with other betalactams.

We present two cases of hypersensitivity to cefazolin (one anaphylaxis). The skin prick tests with cefazolin at therapeutic concentration were positive. For the in vitro study we used conjugates of cefazolin with human serum albumin, obtaining a positive result in the histamine release test in both patients. In one case, we demonstrated anticefazolin-specific IgE antibodies by RAST. The controls did not react to any of these tests. Finally, we carried out skin tests and challenge tests with other betalactam antibiotics, including benzylpenicillin, amoxicillin, aztreonam, cefuroxime and cefotaxime, showing in both patients good tolerance to all these drugs.

Adult↗
PubMedDate not supplied

Perioperative anaphylaxis to cefazolin.

The incidence of generalized reactions during anesthesia has been reported to range from 1 in 5000 to 1 in 25,000 cases with a mortality rate of up to 6%. The most common causes are neuromuscular blocking agents, latex, and antibiotics. Identification of the offending agent may be difficult because multiple medications are administered over a short period. Furthermore, up to 40% of all generalized reactions during anesthesia are non-immunoglobulin E mediated and therefore can not be evaluated by skin testing. We report a case of perioperative anaphylaxis to cefazolin. Sensitization to cefazolin was determined through skin testing, and the patient underwent successful surgery subsequently with the avoidance of cefazolin.

Anaphylaxis↗
PubMedDate not supplied

Cefazolin plus ceftazidime versus imipenem/cilastatin monotherapy for treatment of CAPD peritonitis--a randomized controlled trial.

BACKGROUND: Peritonitis is a serious complication of peritoneal dialysis (PD). We studied the efficacy of imipenem/cilastatin monotherapy in the treatment of PD-related peritonitis. METHODS: We performed an open-label, randomized control study comparing imipenem/cilastatin monotherapy (treatment group) versus cefazolin plus ceftazidime (control group) in the treatment of PD peritonitis. The result was further compared to a historic group treated with cefazolin plus netilmycin. Outcome measures were primary response rate at day 10 and complete cure rate. RESULTS: We enrolled 51 patients in the treatment group, 51 in the control group, and identified 96 in the historic group. The primary response rate to the assigned antibiotics was 49.0%, 51.0%, and 49.0% for the treatment, control, and historic groups, respectively (p = 0.97). The primary response rate allowing for change in antibiotic was 82.4%, 90.2%, and 82.3%, respectively, for the three groups (p = 0.41). The complete cure rate was 72.5%, 80.4%, and 82.3%, respectively (p = 0.60). Tenckhoff catheter removal was needed in 6 cases in the treatment group, 6 cases in the control group, and 13 cases in the historic group (p = 0.90). CONCLUSIONS: We concluded that monotherapy of imipenem/cilastatin has similar efficacy compared to the two standard regimens of cefazolin plus ceftazidime or netilmycin in the treatment of PD peritonitis.

Cefazolin↗
PubMedDate not supplied

Ciprofloxacin and cefazolin as a combination for empirical initial therapy of peritoneal dialysis-related peritonitis: five-year follow-up.

The treatment of peritoneal dialysis (PD)-related peritonitis has been a matter of extensive investigation, frequently generating therapeutic trials. Several combinations of antibiotics have served as newer protocols and tended to be efficacious, comfortable, and cost-effective. According to the more recent recommendations from the International Society for Peritoneal Dialysis, the rationale for empirical initial therapy of clinically detected peritonitis in PD patients has been to follow the bacterial profile derived from cultured specimens of PD effluents. The current study describes 5 year's experience with the use of a new antibiotic regimen for the treatment of peritonitis. We herein analyze the outcome of 95 episodes of peritonitis in 54 patients on either automated PD or continuous ambulatory PD at the dialysis unit of the Federal University of Rio de Janeiro. Peritoneal dialysis-related peritonitis was treated with the combination of oral ciprofloxacin and intraperitoneal cefazolin. The observed cure rate was 85.2% and the sensitivity test was observed to be positive for this combination of antibiotics in 88.9% of positive cultures. Of the 14 unsuccessful episodes, 7 were due to catheter colonization and the rest did not respond to the proposed therapy within 48 hours. These 7 cases were also related to peritoneal fluid cultures that were resistant to both ciprofloxacin and cefazolin. From this study, we propose this combination of oral ciprofloxacin and intraperitoneal cefazolin as a first choice for empirical initial therapy of PD-related peritonitis, given its efficacy and low cost. However, in order to apply the most adequate cost-effective therapy, careful examination of the bacterial profile and sensitivities to antibiotics used in each unit is strongly recommended.

Anti-Infective Agents↗
PubMed1990

Cefazolin for hysterectomy prophylaxis.

Efficacy data for single-dose cefazolin prophylaxis at hysterectomy are meager, and there are none evaluating the impact of route of administration on efficacy. For these reasons, 772 women undergoing elective abdominal or vaginal hysterectomy for benign diseases were given 1 g cefazolin either intramuscularly or intravenously in a randomized clinical trial. Preoperative diagnoses and clinical, surgical, and outcome variables were similar by route of administration for each surgical approach. Risk factors for infection after abdominal hysterectomy included younger age, lower postoperative hemoglobin concentration, and pelvic hematoma; women who developed infection after vaginal hysterectomy were heavier than those who remained uninfected and were more likely to have a pelvic hematoma. The overall incidence of major operative site infection requiring parenteral antimicrobial therapy in evaluable women was 7.2%: 7.6% for 539 women undergoing abdominal hysterectomy and 6.3% for 207 women undergoing vaginal hysterectomy. Postoperative infection was unrelated to route of cefazolin administration.

Cefazolin↗
PubMed1989

Treatment of peritonitis in continuous ambulatory peritoneal dialysis (CAPD) with intraperitoneal cefazolin and gentamicin.

Between 1983 and 1988 57 peritonitis episodes in an unselected patient population were initially treated with intraperitoneal cefazolin and gentamicin. The loading dose consisted of 500 mg cefazolin/L dialysate and 40 mg gentamicin/L dialysate. The maintenance dosage was 125 mg cefazolin and 8 mg gentamicin per liter dialysate. Forty-five (78.9%) patients were primarily cured with this regimen (responder group = RG). Twelve patients (21.1%) did not respond to the initial therapy (nonresponder group = NG). Eight peritonitis episodes in the NG (14.0% of all patients) were caused by tunnel infections and 2 by diverticulitis (3.5%). The cure rate in patients without tunnel infection or bowel disease was 95.7%. A relapse occurred in 2 patients (3.5%). Duration of therapy was assessed by daily white blood cell count (WBC) in the effluent and treatment was discontinued when the WBC was less than 100/microliters for 3 days. The mean duration of therapy with cefazolin and gentamicin was 8.1 days in the RG and 6.0 days in the NG. Nonresponders were subsequently treated with a modified antibiotic regimen on an average 11.9 days.

Catheters, Indwelling↗
PubMed1989

Comparison of one dose cefazolin versus one dose cefotetan for cesarean section prophylaxis.

During one year, 646 women who delivered by cesarean section entered into a prospective randomized clinical trial to determine if a single intraoperative dose of cefazolin was as effective as cefotetan in the prevention of postoperative endomyometritis. Of 336 patients receiving 2 gm cefazolin intravenously at the time of clamping of the cord, endomyometritis developed in 30 (8.91%), and of 310 patients who received 2 gm cefotetan intravenously at the time of clamping of the cord, endomyometritis developed in 36 (11.6%). There was no statistically significant difference in the incidence of endomyometritis between the two groups (p = .269). We conclude that since the two drugs are equal in efficacy 2 gm of cefazolin is a cost effective method of prophylaxis for cesarean section.

Adolescent↗
PubMed1989

[Penetration of cefazolin and methicillin into tissues of rats with aseptic inflammation].

Penetration of cefazolin and methicillin into the tissues of rats with aseptic inflammation was studied. Free cefazolin was shown to be present in blood serum and tissues in higher concentrations than methicillin. The level of cefazolin penetration in all the tested tissues was higher than that of methicillin. Elimination of the antibiotic from the focus of the aseptic inflammation was markedly retarded as compared to that from blood serum. It was suggested that the tissue binding of the antibiotics influenced the rate of their elimination from the tissues.

Animals↗
PubMed1979

Intraocular levels of cefamandole compared with cefazolin after subconjunctival injection in rabbits.

We compared the intraocular pharmacokinetics of cefazolin with those of cefamandole, a recently marketed cephalosporin with enhanced activity against gram-negative bacilli. Following subconjunctival injection of 12.5 mg into infected eyes (S. aureus endophthalmitis) of pigmented rabbits, both drugs reached peak concentrations greater than 100 microgram/gm in cornea, sclera, and choroid-retina. The half-life was markedly shorter in sclera and choroid-retina than in cornea. Levels in the aqueous humor rose and fell more slowly than those in ocular tissues, reaching a maximum of only 5 to 10 microgram/ml. The pharmacokinetics of the two drugs were virtually identical in most intraocular sites. When cefazolin, which was less irritating than cefamandole by the subconjunctival route, was given in a dosage of 100 mg, levels in ocular tissues were increased by twofold to fourfold and in aqueous humor by 15-fold, compared to the concentrations produced by the 12.5 mg dosage. Levels in the vitreous humor were exceedingly low with both drugs; mean peak concentrations were 0.24 microgram/ml after the 12.5 mg dosage of cefamandole and less than 1.6 microgram/ml after the 100 mg dose of cefazolin.

Animals↗
PubMed1987

A comparative study of ofloxacin versus cefazolin in lower respiratory tract infections.

An open study was conducted in 40 randomized patients to evaluate the efficacy of ofloxacin in comparison with cefazolin in the treatment of acute, chronic and recurrent lower respiratory tract infections. The therapeutic efficacy of the two drugs was evaluated on the basis of bacteriological and clinical examinations. Bacteriological assays revealed that ofloxacin eliminated bacterial flora from sputum in 20/21 cases (14 Gram-negative and 7 Gram-positive), while cefazolin eradicated the pathogens in 12/19 cases (16 Gram-negative and 3 Gram-positive). In clinical terms, 20/21 (95.2%) infections were cured and 1/21 (4.8%) improved in the ofloxacin group as against 12/19 (63.2%) cured, 5/19 (26.3%) improved and 2/19 (10.5%) unchanged in the cefazolin group. The results of this study confirm the efficacy and excellent tolerance of ofloxacin in the treatment of lower respiratory tract infections.

Adult↗
PubMed1978

Kinetics of degradation of cefazolin and cephalexin in aqueous solution.

The kinetics of degradation of cefazolin and cephalexin in aqueous solution were investigated at 60 degrees C and constant ionic strength over the entire pH range. The observed degradation rates were obtained by measuring the residual cephalosporin and were shown to follow pseudo-first-order-kinetics. They were influenced significantly by solvolytic and hydroxide ion catalysis. No primary salt effect was observed in the acid or basic pH region. Of the buffer systems employed in the kinetics studies only the phosphate buffer system showed a catalytic effect. The pH-rate profile for cefazolin showed a degradation minimum between pH 5.5 and 6.5. Cephalexin did not show a pH minimum in that region. The apparent energies of activation were determined for cefazolin and cephalexin at pH 5.5 and were calculated to be 24.3 Kcal/mole and 26.2 Kcal/mole, respectively. The agreement between the calculated theoretical pH-rate profiles and the experimental points for both compounds support the hypothesis presented concerning the reactions involved in their respective degradation pathways.

Buffers↗
PubMed1987

Single-dose cefazolin versus cefonicid for antibiotic prophylaxis in cesarean delivery.

The purpose of this prospective investigation was to compare a single intravenous dose of cefazolin to a single dose of cefonicid as prophylaxis for women having unscheduled cesarean delivery. In a double-blind, randomized design, 96 patients were assigned to receive a 1-g dose of cefazolin and 103 patients were designated to receive a 1-g dose of cefonicid. The antibiotics were administered after delivery of the infant. The two groups were comparable with respect to recognized risk factors for postcesarean infection. There were no statistically significant differences between the groups in the incidence of standard febrile morbidity, endomyometritis, urinary tract infection, wound infection, and bacteremia. There were also no significant differences between the groups in the fever index or the duration of hospitalization. We conclude that cefazolin and cefonicid provide a similar degree of prophylaxis against infection in patients having unscheduled cesarean delivery.

Bacterial Infections↗
PubMed1986

Comparison of seven methods of preparing and administering cefazolin sodium small-volume injections.

The time and costs of preparing and administering cefazolin sodium small-volume injections using automated and manual systems were compared. Doses of cefazolin sodium 1 g were prepared in batches of 100 using each of seven methods, and preparation and administration times were recorded during five time trials. Personnel time and total material costs were determined. Bulk-vial reconstitution methods included manual piggyback, manual 24-hour piggyback, and manual syringe systems and one automated syringe infusion method (Bard programmable dispensing pump). Three prefilled container systems (Faspak flexible plastic bags, manufacturers' partial-fill glass bottles, and cefazolin sodium 1-g vials reconstituted using the ADS 100 Physio-Control peristaltic pump and administered via the IVAC CRIS system) were compared with each other and with the bulk reconstitution methods. Of the bulk-vial methods, total preparation process times were significantly shorter for the 24-hour piggyback system. Of the prefilled container systems, total preparation process time was significantly shorter for the Faspak system. Total daily administration process time was shortest for the IVAC CRIS system. Material costs per dose were lowest for the IVAC CRIS system and highest for the syringe pump systems (manual syringe and Bard syringe). Although lowest cost per dose was identified with the IVAC CRIS system, the 24-hour piggyback system was the system of choice on the basis of similar cost savings, its ability to manage primary fluids, and practicality of use at this institution.

Cefazolin↗
PubMed1978

[Bactericidal kinetics of cefazolin, cefoxitin and amikacin alone and in combination (author's transl)].

The in vitro activity of cefazolin, cefoxitin und amikacin alone and in combination was determined via membrane filtration against E. coli (n = 2), K. pneumoniae (n = 2) and of cefoxitin and amikacin against Proteus vulgaris (n = 1). Therapeutically achievable concentrations of cefazolin (10 micrograms/ml), cefoxitin (10 micrograms/ml) and amikacin (10 micrograms/ml) lead to a rapid bactericidal effect against all of our strains. The combination of cefazolin (10 micrograms/ml) and amikactin (5 micrograms/ml) and cefoxitin (10 micrograms/ml and amikacin (5 micrograms/ml) was synergistic against only one of the 2 K. pneumoniae strains. Cefoxitin and amikacin were antagonistic against the P. vulgaris strain but synergistic against both E. coli strains.

Amikacin↗