Cefoxitin: Clinical Evaluation in Thirty-Eight Patients

Thirty-two infants and children ranging in age from 3 to 151 months (mean, 26 months) were treated with parenteral cefoxitin (150 mg/kg per day). Ten patients with isolates of Haemophilus influenzae (six with cellulitis, two with arthritis, and two with mastoiditis), four with Staphylococcus aureus (one with lymphadenitis, one with septicemia, and two with abscess), and three patients with Streptococcus pneumoniae (one each with cellulitis, abscess, and arthritis), were clinically and bacteriologically cured by therapy. Two additional patients with septic arthritis and facial cellulitis developed meningitis with H. influenzae type b and S. pneumoniae, respectively. Minimal inhibitory and bactericidal concentrations were c5 jig/ml for 15 isolates. Minimal bactericidal concentrations were >20 ,ug/ml for one strain of S. aureus and one of H. influenzae type b. The mean peak serum levels were 81.9 and 68.5 ,Ag/ml 15 min after intravenous or intramuscular doses, respectively. The mean elimination half-lives were 42.4 and 40.1 min after intravenous or intramuscular doses, respectively. The mean volumes of distribution were 5,540 and 4,760 ml after intravenous and intramuscular doses, respectively. Mean plasma clearance was 242 and 257 ml/min per m2 after intravenous and intramuscular doses, respectively. Therapy was discontinued in one patient because of neutropenia, which resolved after cefoxitin was stopped. Eosinophilia and transiently elevated liver function tests occurred in eight and six patients, respectively. These data indicate that cefoxitin may be an effective treatment for infections due to susceptible bacteria in the dosage tested, but its use may be limited because of the occurrence of meningitis during therapy in some patients.Cefoxitin is a new semisynthetic ,8-lactam cephamycin antibiotic with a wide in vitro spectrum of antibacterial activity which includes many common pathogens in infants and children such as Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenes, and Haemophilus influenzae (1,3,12). It is also active in vitro against strains of H. influenzae that produce a fi-lactamase (

mentioning

confidence: 99%

“…Preliminary data indicate that cefoxitin is safe and effective in children (9). Although the pharmacokinetics of cefoxitin have been studied in adults (5,8,11) Serum concentrations were plotted against time, using a semi-logarithmic scale. The serum half-life was calculated when blood levels were declining exponentially during the elimination phase.…”

mentioning

confidence: 99%

Clinical and Pharmacokinetic Evaluation of Parenteral Cefoxitin in Infants and Children

Feldman

Moffitt

Sprow

1980

“…otic, has been effective and well tolerated in adults with infections due to susceptible bacteria (3)(4)(5). Its antimicrobial spectrum of activity, which includes gram-positive cocci and Haemophilus influenzae, makes it a potentially useful drug for the parenteral treatment of serious infections in children, which are most often due to these organisms (2) By using the criteria of disk zone size -18 mm and miniimum inhibitory concentration s 16 yg/ml, all of the organisms recovered were susceptible to cefoxitin by the disk diffusion or broth dilution method or both.…”

mentioning

confidence: 99%

Clinical and Bacteriological Evaluation of Cefoxitin Therapy in Children

1979

Cefoxitin, a parenteral cephamycin ,B-lactam antibiotic, was evaluated for safety and efficacy in children with bacterial infections other than meningitis. Twentysix patients between 3 months and 7 years of age were treated with 80 to 160 mg/ kg per day. The most common diagnoses were cellulitis (13 patients), pneumonia (5 patients), and bone and joint infection (4 patients). Nine patients were bacteremic. The most frequently recovered pathogens were Staphylococcus aureus (six patients), Haemophilus influenzae (four patients), and Streptococcus pneumoniae (three patients). All organisms were susceptible to cefoxitin. All 26 children were considered improved or cured. No severe adverse reactions were encountered. Phlebitis (4%), eosinophilia (12%), and elevated liver function tests (4%) were associated with therapy. Cefoxitin appears to be a safe, effective, and welltolerated antibiotic when used in children with susceptible bacterial infections other than meningitis.Cefoxitin, a cephamycin, beta-lactam antibiotic, has been effective and well tolerated in adults with infections due to susceptible bacteria (3-5). Its antimicrobial spectrum of activity, which includes gram-positive cocci and Haemophilus influenzae, makes it a potentially useful drug for the parenteral treatment of serious infections in children, which are most often due to these organisms (2).

“…Cefoxitin is a semisynthetic cefamycin, active in vitro against common meningeal pathogens such as Neisseria meningitidis, Streptococcus pneumoniae, and ampicillin-susceptible and -resistant strains of Haemophilus influenzae type b (1,2,6,8,14,17). The results of clinical trials in adults (6,12,13) and children (2,8) have shown that this drug is safe and effective against infections with S. pneumoniae and H. influenzae b outside the central nervous system.…”

mentioning

confidence: 99%

“…The results of clinical trials in adults (6,12,13) and children (2,8) have shown that this drug is safe and effective against infections with S. pneumoniae and H. influenzae b outside the central nervous system. Thus, cefoxitin has the potential for single-drug therapy for infants and children with suspected bacterial meningitis provided it effectively penetrates into the cerebrospinal fluid (CSF).…”

mentioning

confidence: 99%

Penetration of cefoxitin into cerebrospinal fluid of infants and children with bacterial meningitis

Feldman¹,

Moffitt²,

Manning³

1982

Three consecutive doses of 75 mg of cefoxitin per kg were given intravenously every 6 h (225 mg/kg), in addition to penicillin or ampicillin, to 24 patients on days 4 and 5 and 9 and 10 of therapy for meningitis. Haemophilus influenzae b was isolated from cerebrospinal fluid (CSF) of 21 patients, Streptococcus pneumoniae from 2 patients, and Neisseria meningitidis from 1 patient. The median minimal inhibitory and bactericidal concentrations of cefoxitin for 16 isolates of H. influenzae b were 0.312 and 0.625 micrograms/ml, respectively. Sixteen of 18 isolates of H. influenzae b and S. pneumoniae were killed by 2.5 micrograms of cefoxitin per ml. Mean levels in CSF peaked at 1 h at 6 and 4.9 micrograms/ml on days 5 and 10, respectively. CSF levels on days 5 and 10 were greater than or equal to twice the median minimal inhibitory and bactericidal concentration in 20 and 18 patients, respectively. However, bacterial levels in CSF were greater than or equal to 2.5 micrograms/ml in only 11 of 23 patients on days 5 and 10. No significant adverse effects were found. These data indicate that at this dosage, cefoxitin may not reach levels in the CSF required for killing all susceptible strains of H. influenzae b and S. pneumoniae.