Cefamandole Nafate Therapy of Respiratory Tract, Skin, and Soft Tissue Infections in 74 Patients

Abstract

Cefamandole nafate was given to 52 patients with 53 episodes of skin and soft tissue infections and to 22 patients with respiratory tract infections. The dosage level was 1-2 g administered intravenously every 4-6 hr. Single strains of aerobic gram-positive cocci were isolated from 15 patients with skin and soft tissue infections, mixed aerobic gram-positive cocci from 14, aerobic plus aerobic or anaerobic gram-positive cocci or gram-negative rods from 13, a single aerobic gram-negative rod from one, and aerobic gram-negative rods plus an anaerobic coccus from one. Aerobic grampositive cocci were isolated from four patients with respiratory tract infections, aerobic gram-positive cocci plus aerobic gram-negative rods from nine, and aerobic gram-negative rods from six. Median minimal inhibitory concentrations (MICs) were 0.1 pig/ml for Staphylococcus aureus, Streptococcus pyogenes, Streptococcus agalactiae, and Escherichia coli; 0.1 for Enterobacter aerogenes; and 25 for Streptococcus faecalis. In vivo acquisition of resistance occurred with three strains of S. faecalis and one of E. aerogenes and E. coli. Mean concentrations in serum after administration of 1 and 2 g, respectively, were 58 and 109 ii,g/m1 (peak at 30 min), 2 and 7 (4 hr), and 0.5 and 0.8 (6 hr). Clinical cures were obtained in 48 (91%) of 53 patients with infections of skin and soft tissue, and clinical plus bacteriologic cures were obtained in 36 (6870); clinical cure occurred in 18 (82%) of 22 patients with respiratory tract infections, and clinical plus bacteriologic cures occurred in 16 (73%). Clinical or bacteriologic cures did not necessarily correlate with MICs. Cefamandole was well tolerated. Eosinophilia was observed in 11 patients, enzyme elevations in 10, and phlebitis, rash, fever, and superinfection each in one.