Therapy of staphylococcal infections with cefamandole or vancomycin alone or with a combination of cefamandole and tobramycin

Abstract

Eighty adult patients with microbiologically demonstrated staphylococcal infections were included in a comparative trial of cefamandole and cefamandole plus tobramycin. Patients with cefamandole-resistant pathogens were treated with vancomycin, if the initial therapy consisted of cefamandole, but were continued on cefamandole plus tobramycin if already started on that combination. Of the patients infected with cefamandole-susceptible strains, 91% (20/22) responded favorably to treatment with cefamandole alone, and 88% (30/34) responded favorably to cefamandole plus tobramycin. Of the patients infected with cefamandole-resistant staphylococci, 70%o (7/10) responded to treatment with cefamandole plus tobramycin, and 86%o (12/14) responded to treatment with vancomycin, even though vancomycin therapy was started 24 to 48 h later than cefamandole-plustobramycin therapy. No major side effects were observed; however, cefamandole plus tobramycin was associated with a rise in the serum creatinine level in 11% (4/ 44) of the patients. The bactericidal activity of the serum in cefamandole-treated patients and in cefamandole-plus-tobramycin-treated patients was identical against cefamandole-susceptible strains. Against cefamandole-resistant strains, 87% of the vancomycin-containing sera were bactericidal at a dilution of 1:8, whereas only 57% of the cefamandole-plus-tobramycin-containing sera were active at that dilution.

Clinical comparative study on the activity of cefamandole in the treatment of serious staphylococcal infections caused by methicillin-susceptible and methicillin-resistant strains

“…This clinical study was facilitated by the isolation of methicillin-resistant strains showing susceptibility in vitro to cefamandole, which is in striking contrast with the findings of Coppens et al (2).…”

“…Indeed, all the methicillin-resistant strains isolated by Coppens et al (2) were also resistant in vitro to cefamandole. On the contrary, in our hospitals, the prevalence of methicillin-resistant, cefamandole-resistant strains was low (about 0.5%) both in S. aureus and coagulase-negative staphylococci.…”

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

“…The clinical importance of this in vitro activity is unclear. In many clinical studies failures have been reported when cephalosporins have been used to treat infections caused by methicillin-resistant staphylococci (1,4). This has led to the recommendation that vancomycin be used as the agent of choice for these infections.…”

Aminoglycoside-containing antibiotic combinations for the treatment of bacterial endocarditis: an evidence-based approach

“…The few randomised controlled trials [9][10][11][12][13] in bacterial endocarditis that have compared aminoglycoside-containing combination treatment with monotherapy are briefly described in Table 2. A full description is provided in two systematic reviews [1,14].…”