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PubMed1982

[Treatment and prevention of infections with cefoxitin sodium in patients with biliary tract infections and obstructive jaundice].

UNLABELLED: A total of 24 patients who was hospitalized in the Internal Medicine Wards of Yamaguchi University attached Hospital and the university's 3 related hospitals were administered with cefoxitin. The breakdown of the patients treated with cefoxitin was 7 with cholecystitis, 7 with choledochitis and the remaining 10 for the prevention of infections with obstructive jaundice. Daily doses of 2-6 g of cefoxitin were administered for 6-40 days by intermittent intravenous drip infusion in divided doses. RESULTS: 1. Of 14 patients with biliary tract infections, 10 (71.4%) responded favorably with cefoxitin. 2. Of 10 patients with obstructive jaundice used for the prevention of infections, 8 (80%) responded favorably with cefoxitin. 3. No untoward side effects were observed. 4. Cefoxitin proved to be a safe and effective antibiotic in the treatment of biliary tract infections and for the prevention of infections in patients with obstructive jaundice.

Adult↗
PubMed1994

Comparison of single-dose cefotetan and multidose cefoxitin as intravenous prophylaxis in elective, open biliary tract surgery: a multicentre, double-blind, randomized study.

OBJECTIVE: To compare the safety, tolerance and prophylactic effectiveness of a single 2-g dose of cefotetan with a standard prophylactic regimen of cefoxitin in reducing the incidence of postoperative infections after elective, open biliary tract surgery. DESIGN: Multicentre, double-blind, randomized comparative study with a 4-week follow-up. SETTING: Five Canadian university centres. PARTICIPANTS: One hundred and eleven patients scheduled to undergo elective, open biliary tract surgery. INTERVENTIONS: The patients were randomly assigned to receive either cefotetan or cefoxitin in a ratio of 2:1; 76 patients received cefotetan and 35 received cefoxitin. MAIN OUTCOME MEASURES: Wound infection as defined by the Centers for Disease Control and Prevention and by clinical evaluation, adverse events and laboratory parameters. RESULTS: Two incisional wound infections were reported by patients in the cefotetan group, for an overall infection rate of 1.8% (2 of 111). No significant differences were found in the failure rate or in any other indicator of efficacy. The incidence of adverse events for cefotetan (12.6%) was not statistically different from that for cefoxitin (10.4%), and none of the 16 adverse events in the cefotetan group and 5 in the cefoxitin group was serious or severe. Only one event (rash) was possibly related to the study drugs. Several hematologic and biochemical parameters were found to be normal preoperatively and abnormal postoperatively, but no relation was found between these variations and the study drugs. These changes were mainly attributable to the operation. CONCLUSION: Cefotetan was found to be effective and comparable to cefoxitin, both in safety and in reducing the incidence of infection after elective, open biliary tract surgery.

Adolescent↗
PubMedDate not supplied

Pharmacoeconomic analysis of ampicillin-sulbactam versus cefoxitin in the treatment of intraabdominal infections.

We conducted a retrospective pharmacoeconomic analysis of a prospective, multicenter, double-blind, randomized, controlled trial comparing the beta-lactamase inhibitor combination ampicillin-sulbactam (96 patients) and the cephalosporin cefoxitin (101) in the treatment of intraabdominal infections. An institutional perspective was adopted for the analysis. The primary outcomes of interest were cure and failure rates, development of new infection, and antibiotic-related adverse events. Epidemiologic data pertaining to outcomes was retrieved primarily from the trial, although results of other published studies were taken into consideration through extensive sensitivity analyses. Data pertaining to potential resource use and economic impact were retrieved mainly from the University Health Consortium and hospital-specific sources. When considering only costs associated with drug acquisition through cost-minimization analysis, a potential savings of $37.24/patient may be realized with ampicillin-sulbactam relative to cefoxitin based on an average 7-day regimen. Outcome data collected for the entire hospitalization during the trial revealed an approximately 9% greater frequency of failure with cefoxitin relative to ampicillin-sulbactam. When considering all outcomes of interest in the initial base-case analysis, a potential cost savings of approximately $890/patient may be realized with ampicillin-sulbactam relative to cefoxitin. In assessing the impact of the significant variability in probability and cost estimates, Monte Carlo analysis revealed a savings of $425/patient for ampicillin-sulbactam over cefoxitin (95% CI -$618 to $1516 [corrected]). Given the model assumptions, our analysis suggests a 78% certainty level that savings will be experienced when ampicillin-sulbactam is chosen over cefoxitin.

Abdominal Abscess↗
PubMed1993

Ceftriaxone (single dose) versus cefoxitin (multiple doses): success and failure of antibiotic prophylaxis in 1052 cesarean sections.

The efficacy of perioperative antibiotic prophylaxis in cesarean section with a single dose of ceftriaxone, a long-acting cephalosporin not widely used for prophylaxis, was tested. Ceftriaxone as a single dose of 1 g i.v. versus three doses of cefoxitin 1 g i.v. respectively were used in a prospective, randomized, controlled study consisting of 1052 patients undergoing cesarean section. Postoperative infection rate as measured by fever, endometritis and wound infection was 6.5% with ceftriaxone and 6.4% with cefoxitin. Urinary tract infections were significantly more frequent in the cefoxitin than in the ceftriaxone group (17.8% vs. 9.7%, p < 0.001). Enterococci and Escherichia coli accounted for urinary tract infections 1.86-, respectively, 4.3-fold more frequently with cefoxitin than with ceftriaxone. The time of hospitalization in patients with urinary tract infections was significantly lower with ceftriaxone than with cefoxitin (11 vs. 12 days, p < 0.05). The tolerance in both groups was equally satisfactory. A single dose of ceftriaxone, which is simple, reliable (compliance), well tolerated, inexpensive (fewer urinary tract infections and therefore fewer treatment costs than with cefoxitin) and safe (no overgrowth of pathogens) in our opinion is the antibiotic regimen of choice for prophylaxis in cesarean section in the described circumstances.

Adult↗
PubMed1986

Cefoxitin plus tobramycin and clindamycin plus tobramycin. A prospective randomized comparison in the therapy of mixed aerobic/anaerobic infections.

The efficacy of therapy with cefoxitin sodium plus tobramycin sulfate, with the tobramycin therapy discontinued if no cefoxitin-resistant pathogens grew from appropriate cultures, was compared with clindamycin phosphate plus tobramycin therapy in mixed aerobic/anaerobic intra-abdominal and female pelvic infections. Of 96 evaluable patients, 39 (76%) of 51 randomized to cefoxitin and 38 (84%) of 45 randomized to clindamycin were cured and an additional seven (14%) of 51 and three (6.7%) of 45, respectively, were improved. Bacteroides fragilis "group" was isolated from 44 (54%) of 82 patients with appropriate specimens. Duration of aminoglycoside therapy was significantly shorter in patients randomized to cefoxitin and tobramycin (mean, 4.1 +/- 1.8 days vs 7.0 +/- 3.2 days). There was a tendency to greater nephrotoxic reactions in patients randomized to clindamycin and tobramycin. We conclude that cefoxitin plus tobramycin with selective early discontinuation of aminoglycoside therapy is an acceptable regimen for the therapy of mixed aerobic/anaerobic infections.

Adolescent↗
PubMed1979

Cefoxitin sodium: solution and solid-state chemical stability studies.

Studies were undertaken to provide the basic physicochemical information necessary for preparing a suitable parenteral formulation of cefoxitin sodium. Emphasis was placed on the physico-chemical properties of the compound in solution and in the solid state. Cefoxitin sodium is very soluble in water and exhibits apparent first-order decomposition in this medium at pH 3-9. Maximum stability in water is at pH 5-7. Under these pH conditions, cefoxitin sodium loses about 10% of its activity in 2 days at 25 degrees. Thermal decomposition rates for amorphous and crystalline cefoxitin sodium samples were determined. Amorphous cefoxitin sodium was considerably less stable than its corresponding crystalline form. Solid-state decomposition plots are biphasic, displaying initial rapid losses followed by a slower decay period. The extent of loss in the crystalline solid at the end of the more rapid initial phase can be correlated with the water content of the solid.

Biological Assay↗
PubMed1984

Possible mechanism behind the adjuvant action of phosphate derivatives on rectal absorption of cefoxitin in rats and dogs.

The mechanism underlying the ability of phosphate derivatives to act as adjuvants and coadjuvants was examined in in vivo and in situ preparations in rats and dogs. The adjuvant effect of DL-alpha-glycerophosphate on the rectal absorption of sodium cefoxitin was greatly augmented by the presence of either sodium phytate or sodium tripolyphosphate. These coadjuvants only slightly enhanced cefoxitin rectal absorption when administered alone. Therefore, enhancement of the permeation of tripolyphosphate and phytate by alpha-glycerophosphate may be necessary before the coadjuvants can significantly affect cefoxitin absorption. The inhibitory effect of disodium 4,4'-diisothiocyano-2,2'-disulfonate stilbene, which is known to interact with the amino group in the protein fraction, on enhanced cefoxitin absorption suggests the involvement of the protein fraction in transport of cefoxitin across the rectal membrane.

Adjuvants, Pharmaceutic↗
PubMed1988

Absorption enhancement of rectally infused cefoxitin by medium chain monoglycerides in conscious rats.

The enhancing effect of the medium chain monoglycerides glyceryl-1-monoctanoate (GMO), glyceryl-1-monodecanoate (GMD), and glyceryl-1-monododecanoate (GMDD) on rectal absorption of the cephalosporin antibiotic cefoxitin [(6R,7S)-3-hydroxymethyl)-7-methoxy-8-oxo-7-[2-(2-thienyl)acetamido]-5- thia-1-azabicyclo[4.2.0]oct-2-ene-2-carboxylic acid carbamate (ester)] was investigated in unanesthetized rats. Rectal infusion of 3 mg of cefoxitin sodium without monoglyceride resulted in a mean bioavailability of 31 +/- 18% and a mean residence time (MRT) of 134 +/- 44 min. Coadministration with 53% (w/w) GMO significantly enhanced cefoxitin absorption, resulting in a mean bioavailability of 84 +/- 11% and a mean MRT of 75 +/- 8 min. In a lower concentration, GMD (13% w/w) also significantly promoted cefoxitin bioavailability to 68 +/- 14% and reduced MRT to 70 +/- 11 min. With GMDD only, a trend of increasing bioavailability with increasing monoglyceride concentration was observed, which may be explained by its limited aqueous solubility. Concerning the action of GMO and GMD, the longer monoglyceride is, in terms of effective concentration, more potent in enhancing the extent and rate of cefoxitin absorption. However, a further increase in chain length results in a loss of effect, indicating that the effect of monoglycerides on drug absorption may be determined by their intrinsic absorption enhancing action and solubility.

Administration, Rectal↗
PubMed1985

Pharmacokinetic studies of cefoxitin in continuous ambulatory peritoneal dialysis.

The pharmacokinetics of cefoxitin was examined in 9 patients undergoing peritoneal dialysis for chronic renal failure. Cefoxitin was administered intraperitoneally in the dialysate fluid every 6 h for 24 h, in two different concentrations, 50 micrograms/ml and 100 micrograms/ml. The plasma half-life of cefoxitin was 20.2 h. The major route of elimination was non-renal, with a clearance of 8.0 ml/min. Peritoneal clearance was 4.1 ml/min. As expected, renal clearance was negligible. The peak plasma concentrations of cefoxitin at the two dose levels used were 7 micrograms/ml and 15 micrograms/ml, respectively, when assayed by HPLC, and 12 micrograms/ml and 24 micrograms/ml when determined by a microbiological assay. The cefoxitin concentration in the dialysate decreased from 50 micrograms/ml to 14 micrograms/ml and from 100 micrograms/ml to 37 micrograms/ml during the 6 h of its retention in the peritoneal cavity.

Adult↗
PubMedDate not supplied

The effect of short-term cefoxitin prophylaxis on the colonic microflora in patients undergoing colorectal surgery.

Cefoxitin was administered intravenously to 11 patients undergoing colorectal surgery; the initial dose was 2 g given at the induction of anesthesia followed by two 2 g doses at intervals of six hours. Serum samples and faecal specimens were taken to determine the cefoxitin concentrations. Tissue samples from the gut wall were obtained at surgery. The serum concentrations 15 min after administration ranged from 106.6 to 664.0 mg/l [mean: 295.8 +/- 61.0 (SE) mg/l]. Cefoxitin concentrations in the faecal samples were between 0 and 57.7 mg/kg. Cefoxitin concentrations in the tissue samples varied from 9.0 to 68.3 mg/kg. Faecal samples were also obtained during the investigation period for the cultivation of aerobic and anaerobic bacteria. Enterobacteria decreased and enterococci increased during the first two days. Anaerobic cocci and gram-negative rods also decreased during the same period. The colonic microflora returned to normal after two weeks in all patients and no new colonizing cefoxitin-resistant bacteria were isolated. No postoperative infections occurred.

Adult↗
PubMed1982

Interaction of mezlocillin and cefoxitin against Proteus morganii in the granuloma pouch model.

The interaction of cefoxitin and mezlocillin was studied in rats using the granuloma pouch technique. Proteus morganii strains against which cefoxitin and penicillins exhibited antagonistic antibacterial activity were selected for infection of the pouches. Animals were treated with cefoxitin and/or mezlocillin, and bacterial counts, drug levels and beta-lactamase production in the pouch exudate monitored. A significant decrease in bacterial counts was seen after administration of mezlocillin and cefoxitin in combination but not after the drugs administered alone. Drug concentrations of mezlocillin and/or cefoxitin corresponded directly to the rate of induction of beta-lactamase activity. Although both beta-lactam antibiotics induce beta-lactamase activity, administered in combination in vivo they appear to protect each other from being inactivated thus resulting in synergistic antibacterial activity.

Animals↗
PubMed1988

Pharmacokinetics of three-dose cefoxitin prophylaxis in caesarean section.

A pharmacokinetic analysis of cefoxitin in women undergoing caesarean section under general anaesthesia, was performed. In order to prevent infections postoperatively three doses of cefoxitin--2, 1 and 1 g, respectively--were given as a 3-min intravenous infusion at 6-h intervals. In vitro growth of most pathogens is inhibited at a cefoxitin concentration of 16 micrograms/ml. In the sera of the patients, this antibiotic level was maintained for a period of 90-100 min after the first administration (2 g) and 45-50 min after the second and the third administration of cefoxitin (1 g). The period of subinhibitory antibiotic concentrations lasted 270 and 315 min, respectively. How can one reach prolonged antibiotic coverage? In order to minimize antibiotic pressure on hospital flora it is advisable not to increase the total amount of antibiotic (4 g) administered. By starting a 310 mg/h infusion after the initial 2 g bolus injection, the serum concentration of cefoxitin can be maintained at a minimum level of 16 micrograms/ml during a period of 6.5 h. The improvement of antibiotic administration suggested requires further clinical testing.

Cefoxitin↗
PubMed1986

Sulbactam/ampicillin compared with cefoxitin for chemoprophylaxis in elective colorectal surgery.

In a prospective, randomized, comparative study, patients undergoing elective major colorectal surgery received four six-hour doses of either sulbactam (a beta-lactamase inhibitor) with ampicillin (1 gm with 1 gm), or cefoxitin (2 gm) commencing at induction of anesthesia. The groups were well matched for age, sex, diagnosis, and surgical procedures. Three patients in the sulbactam group (N = 44), and four in the cefoxitin group (N = 48) developed significant wound sepsis. Minor wound sepsis occurred in an additional four sulbactam patients, and in five cefoxitin patients. There was no difference between the groups in deep sepsis or anastomotic leak rates (sulbactam, four patients; cefoxitin, seven patients). No serious side effects were recorded in either group. These results suggest that sulbactam combined with ampicillin provides a safe, effective alternative to cefoxitin for prophylaxis in colorectal surgery.

Aged↗
PubMed2005

Do antimicrobial susceptibility patterns of colonic isolates of Bacteroides species change after antibiotic prophylaxis with cefoxitine during elective abdominal surgery?

The objectives of the study were to investigate and compare the susceptibility profiles of preoperative and postoperative intestinal Bacteroides fragilis and Bacteroides thetaiotaomicron strains against antimicrobials to evaluate their resistance development patterns due to prophylactic antibiotic administration. Preoperative and postoperative stool samples were obtained from patients undergoing elective abdominal surgery with a "clean-contaminated" wound categorization. All patients received cefoxitin 2 g as prophylaxis. Isolates of Bacteroides species were identified. Susceptibility tests against ampicillin, piperacillin, cefoxitin, clindamycin, chloramphenicol, metronidazole, imipenem, and amoxicillin-clavulanate were performed. Stool samples were collected from 40 patients at two settings: before and after the operation. Most of the patients (53%) were operated on because of colorectal carcinoma and underwent surgery that included colectomy or anterior resection. Bacteroides fragilis and Bacteroides thetaiotaomicron were isolated in both samples obtained from 22 and 34 patients, respectively. In the present study 95% to 100%, 50% to 74%, 46% to 64%, and 18% to 35% of preoperatively isolated Bacteroides species were resistant to ampicillin, cefoxitin, clindamycin, and piperacillin, respectively. Although there were no statistically significant difference, postoperative strains were more resistant than preoperative isolates, and the resistance rates were found to be 95% to 100%, 55% to 82%, 46% to 86%, and 37% to 41%, respectively. Both Bacteroides species isolated from all specimens before and after the surgery were uniformly susceptible to amoxicillin-clavulanate, imipenem, metronidazole, and chloramphenicol.Our data revealed that Bacteroides strains revealed high resistance to ampicillin, cefoxitin, piperacillin, and clindamycin. Metronidazole, imipenem, and amoxicillin-clavulanate seem highly effective against both Bacteroides species. Cefoxitin prophylaxis did not significantly increase the resistance patterns against antimicrobial agents.

Adult↗
PubMed2006

Plasmid-related resistance to cefoxitin in species of the Bacteroides fragilis group isolated from intestinal tracts of calves.

Species of the Bacteroides fragilis group are considered the most common anaerobe in human and animal infections and also harbor plasmids conferring resistance to several antibiotics. In this study, resistance to cefoxitin, plasmid profile and beta-lactamase production in species of the B. fragilis group isolated from intestinal tracts of calves were evaluated. One hundred sixty-one B. fragilis group bacteria isolated from calves with and without diarrhea were analyzed. Cefoxitin susceptibility was performed using an agar dilution method, beta-lactamase production by using a nitrocefin method, and plasmid extraction by using a commercial kit. Minimal inhibitory concentration values for cefoxitin ranged from 32 to > 512 microg/ml, and 47 bacteria (29.2%) were resistant to cefoxitin (breakpoint 16 microl). Only seven isolates harbored plasmids varying from 6.0 to 5.0 kb, and a 5.5-kb plasmid in B. vulgatus Bd26e and B. fragilis Bc5j might be related to cefoxitin resistance. beta-lactamase was detected in 33 (70.2%) isolates. The cepA gene was observed in total DNA and in the 5.5-kb plasmid. The plasmid presence in organisms isolated from cattle may be important in ecologic terms, and it needs further study.

Animals↗
PubMed1983

Multicenter comparison of cefoxitin versus cefazolin for prevention of infectious morbidity after nonelective cesarean section.

A randomized double-blind placebo-controlled comparison of prophylactic cefoxitin, an antibiotic with good activity against anaerobic bacteria, with cefazolin, an agent effective predominantly against aerobes, was undertaken in 354 women who underwent nonelective cesarean section (124 receiving cefoxitin, 119 cefazolin, and 111 placebo). Among the placebo group, 24.3% developed genital tract-related infection, in comparison to 5.6% of the cefoxitin patients and 6.7% of the cefazolin patients (P less than 0.001). Standard febrile morbidity, fever index, and duration of postoperative hospital stay were also significantly less in the antibiotic prophylactic groups. For patients with febrile morbidity, the mean fever index was less in the cefoxitin group (24.8 degree-hours) than that in the cefazolin group (42.7 degree-hours), and this difference approached statistical significance (P less than 0.1, greater than 0.05). Postoperative hospital stay longer than 1 week for infectious morbidity occurred in 26% of cefoxitin patients, a significantly lower incidence compared to the 66% rate for patients who received cefazolin, and the 57% incidence for patients in the placebo group (P less than 0.05).

Adult↗
PubMed1982

Short-term systemic prophylaxis with cefoxitin and doxycycline in colorectal surgery. A prospective, randomized study.

The efficacy of cefoxitin or doxycycline as antibiotic prophylaxis in colorectal surgery was compared in 102 elective operations. Both drugs were used perioperatively only. Cefoxitin was used in 55 cases and doxycycline in 47. Ten patients in the cefoxitin group and 4 in doxycycline group had wound infections. Three intraabdominal abscesses were seen, one after cefoxitin and two after doxycycline prophylaxis. All three were due to anastomotic leakage. Bacteriologic studies revealed no negative ecologic effects of prophylaxis. The short-term prophylaxis used did protect against serious infectious complications. The extended spectrum of cefoxitin provided no added benefit in prophylaxis. Patients with inflammatory bowel disease treated preoperatively with salicylazosulfapyridine run a greater risk of postoperative infection in spite of the prophylaxis.

Adult↗
PubMed1981

Evaluation of cefoxitin prophylaxis for cesarean section.

Prophylactic cefoxitin was evaluated in 101 patients undergoing cesarean section. A three-dose regimen of either cefoxitin or placebo was administered randomly in a double-blind manner, 46 patients receiving cefoxitin and 55 placebo, with the first dose given after the cord was clamped. In the placebo group, 29% of the patients developed pelvic or wound infection, compared to 4% in the cefoxitin group (P less than 0.003). No patient required re-operation, re-admission, or had a life threatening infection. Ten risk factors for infection were analyzed to help ascertain which patients would benefit from prophylaxis. Cefoxitin, with a broad spectrum of aerobic and anaerobic coverage, was found to be an effective and safe prophylactic agent when given to all patients undergoing cesarean section.

Adult↗