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Comparison of ceforanide, cefazolin, methicillin, and nafcillin in Staphylococcus aureus endocarditis therapy in rabbits.

Ceforanide (30 mg/kg) administered every 12 h, cefazolin (20 mg/kg) administered every 8 h and methicillin or nafcillin (40 mg/kg) administered every 6 h were equally effective in reducing the number of Staphylococcus aureus in vegetations in rabbits with endocarditis. These treatments were more effective than methicillin or nafcillin administered every 12 h. Ceforanide produced higher peak concentrations and greater bactericidal activity in serum than the other drugs and had the longest half-life (5.8 h, compared with 0.4 to 0.8 h for the other agents.

Animals↗

In vitro and in vivo morphological response of Klebsiella pneumoniae to cefotiam and cefazolin.

The effect of cefotiam and cefazolin on the ultrastructure of Klebsiella pneumoniae DT-S in vitro and in experimental pneumonia in mice was examined by electron microscopy. The action of both cephalosporins against K. pneumoniae DT-S was bactericidal, and a dose response in the action was definite. At the minimal inhibitory concentration of each cephalosporin, filamentation of the cells was induced and the cytoplasm became sparse during the course of incubation. With elevation of the concentration of the cephalosporins, spheroplasts were formed; they subsequently collapsed. In the lungs of mice, the infecting organisms localized in the alveolar space, and each cell was connected by a threadlike material. A fibrous matrix, located on the cell surface of the infecting organisms, was observed in ultrathin sections. By administration of each cephalosporin to mice, several morphological changes, similar to those noted in vitro, were observed in the infecting organisms.

Animals↗

Activity of LY146032 compared with that of methicillin, cefazolin, cefamandole, cefuroxime, ciprofloxacin, and vancomycin against staphylococci as determined by kill-kinetic studies.

Kill-kinetic methods were used to provide data on the bactericidal activity of subinhibitory (0.5x MIC), inhibitory (1x MIC), and suprainhibitory (4x MIC) concentrations of LY146032 against methicillin-susceptible and -resistant Staphylococcus aureus and Staphylococcus epidermidis. These bactericidal activities were compared with those of methicillin, cefazolin, cefamandole, cefuroxime, ciprofloxacin, and vancomycin. LY146032 was among the most active of the antistaphylococcal agents tested, as determined by broth microdilution methods, with all strains being inhibited at concentrations of less than or equal to 1 microgram/ml. Time kill-kinetic studies demonstrated that at 4x MIC, LY146032 was rapidly bactericidal against all strains of staphylococci. Our data show that LY146032 has significant bactericidal activity against staphylococci in comparison with other antistaphylococcal agents. Further evaluation of LY146032 against serious staphylococcal infections is warranted.

Anti-Bacterial Agents↗

Alterations in pharmacokinetics and protein binding behavior of cefazolin in endotoxemic rats.

The possible alterations in the pharmacokinetics and protein binding behavior of the beta-lactam antibiotic cefazolin (CEZ) were investigated in endotoxemic rats induced by Klebsiella pneumoniae O3 lipopolysaccharide (LPS). LPS (250 micrograms/kg of body weight) was infused for 20 to 30 min 2 h before an intravenous administration of CEZ (20 mg/kg). Significant decreases in systemic clearance and renal clearance of CEZ were observed in LPS-treated rats without any changes in fraction of urinary excretion in unchanged CEZ (> 0.8). The volume of distribution at steady state showed a tendency to increase. The protein binding parameters of CEZ, the binding capacity, and number of binding sites on the albumin molecule were decreased by LPS, whereas the dissociation constant did not change. Significant decreases in systemic and renal clearances for unbound CEZ were observed in LPS-treated rats. The glomerular filtration rate estimated as inulin clearance was also decreased by LPS. The ratio of renal clearance of unbound CEZ to glomerular filtration rate (clearance ratio) dropped to 70% of that in control rats, and the net tubular secretion of CEZ was also dramatically reduced. The present study suggests that LPS has an effect on the pharmacokinetics of CEZ by changes which occur in renal handling and protein binding.

Animals↗

Absorption, distribution and elimination of cefazolin in patients with normal renal function.

Cefazolin was given intramuscularly in a dosage of 1.0 g to 13 bed-ridden patients during treatment for various infections, and the pharmacokinetics evaluated in each subject. In 9 patients the mean serum half-life was 2.7 h, whereas in 4 patients--all over 60 years of age--it was significantly above this value. Impaired renal fuction could not explain the prolonged excretion time in the last group.

Absorption↗

Pharmacokinetics of cefazolin in patients with renal failure; special reference to hemodialysis.

The pharmacokinetic constants of cefazolin were determined comparatively in ten normal subjects, 12 patients with renal failure, and ten patients on repeated hemodialysis. Significant correlations could be established between the creatinine clearance values and the overall elimination rate constants (Ke), serum half-lives (T 1/2), plasmatic areas (Ftot), urinary recoveries (uo-6 hr), and renal clearances of the antibiotic (Cr). The pharmacokinetic changes produced by extrarenal removal were also studied. On the basis of the obtained results, a dosage schedule adjusted to renal status was proposed.

Cefazolin↗

The effects of haemofiltration on cefazolin levels during cardiopulmonary bypass.

Ultrafiltration has been shown to affect cardiac drug concentrations during cardiopulmonary bypass (CPB), based on their respective pharmacological properties. In an attempt to understand the aetiology of sternal wound infections, a study was performed to eliminate the use of ultrafiltration as a possible cause. We compared cefazolin levels at three time intervals during the course of routine CPB with ultrafiltration to those levels in a control group in which ultrafiltration was not used. Our results indicate that there is little difference in the rate of decay of antibiotic levels with or without the use of a haemoconcentrator. This implies that ultrafiltration procedures do not put the patient at any increased risk for infection and that additional measures beyond that which we would normally use at our institution need not be taken.

Blood Proteins↗

Combination of amikacin and carbenicillin with or without cefazolin as empirical treatment of febrile neutropenic patients. The International Antimicrobial Therapy Project Group of the European Organization for Research and Treatment of Cancer.

A total of 841 febrile neutropenic patients from 20 centers were randomized to receive carbenicillin (or ticarcillin) plus amikacin or these antibiotics plus cefazolin to compare outcome and incidence of nephrotoxicity. Infection with Escherichia coli, Klebsiella species, Pseudomonas aeruginosa, or Staphylococcus aureus accounted for most of the microbiologically documented febrile episodes. The response to therapy was similar in the two treatment groups for all infections and for bacteremia. Improvement occurred in 35 (64%) of 55 bacteremic patients treated with two antibiotics and 39 (65%) of 60 treated with three antibiotics. An increase in serum creatinine to 2 mg/dL over baseline occurred in eight (2.1%) of 381 patients in the former and in 50 (2.4%) of 364 patients in the latter group. Thus, the two antibiotic regimens were equal in efficacy and in nephrotoxicity. Although not the primary focus of this study, a significant decrease in incidence of infection, including bacteremias, was found in neutropenic patients treated with any oral intestine decontamination regimen.

Agranulocytosis↗

[Comparison of the effects of prophylactic antibiotic therapy and cost-effectiveness between cefazolin (CEZ) and Sulbactam/Ampicillin (SBT/ABPC) in gastric cancer surgery employing clinical pathway].

The present study was designed to investigate the effects of prophylactic antibiotic therapy and the cost-effectiveness of Cefazolin (CEZ) and Sulbactam/Ampicillin (SBT/ABPC) in gastric cancer surgery employing clinical pathway. 157 patients (62 in the CEZ group and 95 in the SBT/ABPC group), who underwent surgery for gastric cancer at the First Department of Surgery of our hospital, were investigated. There was no significant difference between the groups with regard to sex, age, incidence of complication, stage of cancer, surgical method, operative time and blood loss, length of hospitalization, the appearance of systemic inflammatory response syndrome (SIRS), changes body temperature, white blood cell count (WBC), C-reactive protein (CRP), or clinical outcome of postoperative care by a nurse during post-operation for 7 days. The prophylactic effect of infection was also no different between the CEZ (69.4%) and SBT/ABPC (69.5%) groups. In contrast, decision analysis strongly indicated that the anticipate cost of antibiotics was higher in the latter group (yen 20402) than in the CEZ group (yen 15556), suggesting that the prophylactic effect of CEZ may be more cost-effective. Thus, evaluations of pharmacotherapy from the aspect of cost may be one of the important responsibility of hospital pharmacists in the future.

Aged↗

Effect of isoniazid on the pharmacodynamics of cefazolin-induced seizures in rats.

Both isoniazid (INH) and cefazolin (CEZ) can have serious adverse effects on the central nervous system (CNS), causing seizures. In this study, we investigated the effect of INH on the pharmacodynamics of CEZ-induced seizures in rats. Male Wistar rats pretreated with INH (150 mg/kg i.p.) or saline received an intravenous infusion of CEZ at 3.2 g/h/rat until the onset of seizures, then samples of cerebrospinal fluid (CSF), blood (for serum), and brain were obtained immediately. The administration of INH was associated with a reduction in the total dose of CEZ required to produce seizures. The concentrations of CEZ in serum, brain, and CSF in INH-treated rats at the onset of seizures were significantly lower than those in control rats. In rats coadministered with pyridoxine (150 mg/kg s.c.), the concentration of CEZ in CSF at the onset of seizures was significantly higher than that in rats administered INH only. These results suggest that INH potentiates the sensitivity of the CNS to CEZ-induced seizures, and that the increased sensitivity is associated with the inhibition of vitamin B(6) metabolism by INH.

Animals↗

Penetration of cephradine and cefazolin into ulcers of patients suffering from peripheral arterial circulatory insufficiency.

11 patients with peripheral arterial circulatory insufficiency with ulcers on the big toe or on the heel were given 1 g of cephradine intravenously (i.v.) and later 1 g of cefazolin i.v., two cephalosporins with different degrees of protein binding. Antibiotic concentrations were followed in serum and wound secretions after the injections. The peripheral circulatory state of the patients and the degree of protein binding of the cephalosporins used seemed to be of minor importance for the concentrations of the antibiotics in the ulcers, i.e. the infectious focus, compared to local factors such as the bacterial flora of the ulcers. In-vitro studies with bacterial strains isolated from the ulcers of 2 of the patients indicated that beta-lactamases from gram-negative bacteria might be at least part of the explanation for the low concentrations in wound secretion of one or other of the agents used in 4 out of the 11 patients.

Aged↗

Studies on protein binding of antibiotics. I. Effect of cefazolin on protein binding and pharmacokinetics of cefoperazone.

The effect of cefazolin (CEZ) on the protein binding and the pharmacokinetics of cefoperazone (T-1551) was investigated. For the simultaneous determination of T-1551 and CEZ, high pressure liquid chromatography (HPLC) was used. The extent of protein binding, the number of binding sites and the association constant to human serum albumin were 90.4%, 0.87 and 2.16 X 10(4) in T-1551, and 89.2%, 0.78 and 2.46 X 10(4) in CEZ, respectively. T-1551 and CEZ appeared to bind to the same site on the protein, since each drug competitively inhibited the binding of the other to serum protein. The mode of the binding of T-1551 to serum protein was similar to that of CEZ. When T-1551 and CEZ were co-administered, the serum level of T-1551 was lower than that with the single administration, while, urinary excretion was higher. These results suggested that the concomitantly administered drugs influenced one another's binding to serum protein in vivo and subsequently an increase in the concentration of the unbound drug in the serum made the drug available for glomerular filtration. It seemed that the high protein binding of T-1551 to serum was an important factor affecting its pharmacokinetics.

Animals↗

Studies on protein binding of antibiotics. II. Effect of apalcillin on protein binding and pharmacokinetics of cefoperazone and cefazolin.

The drug-protein interactions between cefoperazone (CPZ) and apalcillin (APPC), and between cefazolin (CEZ) and APPC were investigated in in vitro and in vivo experiments. Through the binding rates of CPZ or CEZ to rabbit serum and human serum albumin subsided remarkably with increased drug concentrations, APPC was not greatly affected, even at high concentrations. It appeared that APPC had a higher binding capacity to protein than CPZ or CEZ. From the results of competitive study, it became clear that APPC partially shared the binding sites on protein with CPZ or CEZ. The CPZ or CEZ serum levels in rabbits administered together with APPC were not different from those for the single administration, but APPC levels for the simultaneous administration were slightly lower.

Ampicillin↗

Studies on protein binding of antibiotics. III. Effect of novobiocin on protein binding and pharmacokinetics of cefoperazone and cefazolin.

The drug-protein interactions between cefoperazone (CPZ) and novobiocin (NB), and between cefazolin (CEZ) and NB were investigated. Though there was a remarkable reduction of CPZ or CEZ binding to rabbit serum and human serum albumin with increases in drug concentrations above 3.0x10-4M (CPZ: 200 microgram/ml, CEZ: 140 microgram/ml), NB binding was not affected. In addition, when CPZ or CEZ was added to the NB solution, NB binding was not altered and remained above 90%. Therefore, it was evident that NB had a high capacity for binding to protein, compared with CPZ or CEZ. From the competitive study, the main binding site of NB to protein appeared to differ from that of CPZ or CEZ. The CPZ or CEZ serum levels in rabbits for the simultaneous adminstration of NB were significantly higher than those for the control experiments, however, the NB serum levels were not greatly affected by CPZ or CEZ.

Animals↗

Pharmacokinetic studies on the concomitant administration of piperacillin and cefazolin, and piperacillin and cefoperazone in rabbits.

The pharmacokinetics of each drug on the concomitant administration of piperacillin (PIPC) and cefazolin (CEZ) or cefoperazone (CPZ) were studied in rabbits. When rabbits received the consecutive drip infusion administration of CEZ (0.71 mg/kg/minute) and PIPC (1.38 mg/kg/minute) and likewise of CPZ (0.72 mg/kg/minute) and PIPC (1.54 mg/kg/minute) for 1 hour, respectively, the serum half-lives of CEZ and CPZ were respectively prolonged about 1.8 and 1.6 times during drip infusion of PIPC than administered alone. However, when the sequence of administration were reversed, the serum levels of PIPC were not affected by the consecutive drip infusion administration of CEZ and CPZ. To study these findings in detail, the single intravenous dose of 20 mg/kg of CEZ and CPZ were administered under drip infusion of PIPC (2.65-2.93 mg/kg/minute). The serum half-lives of CEZ and CPZ were also prolonged about 5.4 and 1.9 times, respectively, whereas urinary excretion of CEZ, and urinary and biliary excretion of CPZ were reduced by PIPC. Moreover, when the single intravenous dose of 20 mg/kg of PIPC were administered under drip infusion administration of CEZ (0.96-2.60 2.60 mg/kg/minute), the pharmacokinetics of PIPC was not affected by the presence of CEZ. However, under drip infusion administration of CPZ (2.60-2.70 mg/kg/minute), the PIPC serum half-life was prolonged about 1.4 times, and biliary excretion of PIPC was reduced but urinary excretion was not. From the results of renal clearance experiments, tubular secretion appeared to be the predominant mechanism of renal elimination for these three drugs. These results indicate that PIPC influences the pharmacokinetics of both drugs by the competitively inhibiting tubular secretion in CEZ, and tubular secretion and hepatic transport system in CPZ. Therefore, in this respect PIPC seems to have probenecid-like action.

Animals↗

An automatic substitution policy for cefazolin.

An automatic substitution policy was developed at Lions Gate Hospital whereby all orders for cefazolin to be administered Q6H were changed to Q8H without contacting the physician. Exceptions were made if "no substitution" was requested by the physician. Anticipated annual savings for drug and non-drug costs were $13,810 and $12,431 respectively, based on four months of the intervention. This policy proved to be a useful intervention in controlling drug costs at our institution and similar interventions will be considered in the future.

Canada↗

The in vivo and in vitro comparative nephrotoxicity of cefazolin and gentamicin.

Biochemical, histopathological and cell culture evaluations compared the nephrotoxicity of cefazolin with that of gentamicin. New Zealand rabbits were dosed with 250 mg cefazolin/animal i.m. twice daily, 3 mg gentamicin/kg i.m. twice daily, or 0.9% NaCl solution for 10 d. The rabbits in drug-treated groups had necrosis of proximal kidney tubules and elevated urinary-gamma glutamyl transferase (uGGT) levels. The results of the histopathological examinations, uGGT analyses and effects in cell culture indicated the nephrotoxicities of both antibiotics were similar.

Animals↗

[Infection prophylaxis in open leg fractures. Comparison of a dose of pefloxacin and 5 days of cefazolin-oxacillin. A randomized study of 616 cases].

THE PURPOSE OF THE STUDY: Was to compare the efficacy of a single 800 mg injection of Pefloxacin (PF) versus 2 days of cefazolin (1 gr.Q.6 H) followed by 3 days of oxacillin (1 gr.Q.8 H) in patients with an open tibial fracture and to examine the predictive factors for infection. A double-blind double dummy, multicentric, randomized trial was performed. 616 adults with an open tibial fracture requiring single-stage bone coverage were included. The end point was wound infection within 3 months. RESULTS: Within 3 months, 21/316 patients were infected in the PF group (6.6 p. 100) versus 24/300 in the CZ-OX group (8 p. 100), the difference was not significant (95 p. 100 Cl for difference: -4.8 p. 100 to 2.1 p. 100). Twenty one strains were isolated in 18 infected patients in the PF group, and 27 in 20 patients in the CZ-OX group. Negative gram bacteria were less frequent in the PF group (10 p. 100) than in the CZ-OX group (48 p. 100), and positive gram bacteria were more frequent in the PF group (90 p. 100) than in the CZ-OX group (52 p. 100). Independent risk factors for infection were severe contamination, widespread contusion, unstable fracture, positive sample in the emergency room and at the end of surgery. Resistant infecting bacteria rate was 24 p. 100 in infected cases. CONCLUSION: There was no difference in infection rates after surgery for open tibial fractures between a 800 mg injection of Pefloxacin and 2 days of pephazolin followed by 3 days of oxacillin. Infecting bacteria were mainly nosocomially acquired.

Adult↗