Journal of Antimicrobial Chemotherapy (1978) 4 (Suppl. B), 255-256
Cefoxitin sodium in complicated urinary tract infection
Department of Renal Medicine, Christchurch Hospital, Christchurch, New Zealand The efficacy of cefoxitin sodium was studied in the treatment of urinary tract infections in 20 patients, some with severely impaired renal function. Qinically, there were 14 cures and 6 improvements. Bacteriologically, 17 patients were cured, 2 relapsed, and 1 suffered a superinfection with a resistant Pseudomonas. Introduction
A study was undertaken to assess the efficacy of cefoxitin sodium in the treatment of urinary tract infection in 20 patients with normal or reduced renal function. Methods
The patients treated were all in-patients at Christchurch Hospital with bacteriologically proven urinary tract infections. The organisms isolated were Escherichia coli (4), Proteus mirabilis (6), Klebsiella spp. (6), Staphylococcus epidermidis (2), Staph. aureus (1), and Streptococcus faecalis (1). Ten of the 20 patients had normal or nearly normal renal function, i.e., serum creatinine concentration was 016mmol/l (1-7 mg%) or less, whereas 10 others showed impairment of renal function (serum creatinine concentration between 0-25 and 1-5 mmol/1, equivalent to 2-7to 16-5 mg%).The dosage of cefoxitin was 2 g i.v. every 8 h in patients with severe disease and 1 g i.m. every 8 to 12 h in patients with less severe disease. Cefoxitin levels were assayed in nine urine and three serum samples using a microbiological assay method (Bennett, Brodie, Benner & Kirby, 1966). Results
The results of treatment were similar in patients with normal renal function and in those with renal impairment. Clinically, 7 patients in each group were cured and 3 showed improvement. By bacteriological criteria, 8 of the 10 patients with normal renal function were cured, whereas 2 relapsed after completion of therapy. The organisms isolated from these 2 patients were Strep, faecalis from 1 and P. mirabilis from the other. Nine patients with impaired renal function were cured, and 1 suffered superinfection by a resistant Pseudomonas species. The probable reason for the success of cefoxitin in the treatment of urinary tract 0305-7453/78/0701-B255 $01.00/0
255 © (1978) The British Society for Antimicrobial Chemotherapy
Downloaded from http://jac.oxfordjournals.org/ at University of Bath Library & Learning Centre on July 7, 2015
P. J. little, B. A. Peddie and S. Pearson
256
P. J. little, B. A. Peddie and S. Pearson
Table L Random urinary levels of cefoxitin after i.m. injection of 1 g every 8 to 12 h
Case no. 1 2 3 4 5 6 7 8 9
GFR (ml/min)
Random urinary concentration of cefoxitin
2 4 5 5 8 10 14 15 40
(/ig/ml)
300 72 180 380 620 975 450 740 1880
* GFR = glomerularfiltrationrate. Cefoxitin sodium must be considered among the drugs of choice in the parenteral treatment of severe urinary tract infection, particularly in cases in which the level of renal function is either depressed or unknown. References Bailey, R. R. & Peddie, B. A. Tobramycin in the treatment of severe and complicated urinary tract infections. New Zealand Medical Journal 84: 1-3 (1976). Bennett, J. V., Brodie, J. L., Benner, E. J. & Kirby, W. M. M. Simplified accurate method for antibiotic assay of clinical specimens. Applied Microbiology 14: 170-7 (1966).
Downloaded from http://jac.oxfordjournals.org/ at University of Bath Library & Learning Centre on July 7, 2015
infection in these patients is that the drug is excreted in adequate concentrations in the urine, even in patients with severe impairment of renal function. Serum levels of cefoxitin in patients with severe renal impairment ranged from 41 to 193 ^g/ml. Urinary levels of cefoxitin ranged from 72 /ig/ml, in a patient with a glomerular filtration rate (GFR) of 4 ml/min, to 1880 ^g/ml in a patient wtih a GFR of 40 ml/min (Table I). This urinary concentration of antibiotic contrasts sharply with the results obtained with aminoglycoside antibiotics (Bailey & Peddie, 1976). Because of the ototoxic hazard of aminoglycoside antibiotics, serum levels of those drugs must be kept below lO^g/ml; in patients with severe impairment of renal function, urinary levels of the antibiotic may not reach even that level.
Cefoxitin sodium in complicated urinary tract infection
Department of Renal Medicine, Christchurch Hospital, Christchurch, New Zealand The efficacy of cefoxitin sodium was studied in the treatment of urinary tract infections in 20 patients, some with severely impaired renal function. Qinically, there were 14 cures and 6 improvements. Bacteriologically, 17 patients were cured, 2 relapsed, and 1 suffered a superinfection with a resistant Pseudomonas. Introduction
A study was undertaken to assess the efficacy of cefoxitin sodium in the treatment of urinary tract infection in 20 patients with normal or reduced renal function. Methods
The patients treated were all in-patients at Christchurch Hospital with bacteriologically proven urinary tract infections. The organisms isolated were Escherichia coli (4), Proteus mirabilis (6), Klebsiella spp. (6), Staphylococcus epidermidis (2), Staph. aureus (1), and Streptococcus faecalis (1). Ten of the 20 patients had normal or nearly normal renal function, i.e., serum creatinine concentration was 016mmol/l (1-7 mg%) or less, whereas 10 others showed impairment of renal function (serum creatinine concentration between 0-25 and 1-5 mmol/1, equivalent to 2-7to 16-5 mg%).The dosage of cefoxitin was 2 g i.v. every 8 h in patients with severe disease and 1 g i.m. every 8 to 12 h in patients with less severe disease. Cefoxitin levels were assayed in nine urine and three serum samples using a microbiological assay method (Bennett, Brodie, Benner & Kirby, 1966). Results
The results of treatment were similar in patients with normal renal function and in those with renal impairment. Clinically, 7 patients in each group were cured and 3 showed improvement. By bacteriological criteria, 8 of the 10 patients with normal renal function were cured, whereas 2 relapsed after completion of therapy. The organisms isolated from these 2 patients were Strep, faecalis from 1 and P. mirabilis from the other. Nine patients with impaired renal function were cured, and 1 suffered superinfection by a resistant Pseudomonas species. The probable reason for the success of cefoxitin in the treatment of urinary tract 0305-7453/78/0701-B255 $01.00/0
255 © (1978) The British Society for Antimicrobial Chemotherapy
Downloaded from http://jac.oxfordjournals.org/ at University of Bath Library & Learning Centre on July 7, 2015
P. J. little, B. A. Peddie and S. Pearson
256
P. J. little, B. A. Peddie and S. Pearson
Table L Random urinary levels of cefoxitin after i.m. injection of 1 g every 8 to 12 h
Case no. 1 2 3 4 5 6 7 8 9
GFR (ml/min)
Random urinary concentration of cefoxitin
2 4 5 5 8 10 14 15 40
(/ig/ml)
300 72 180 380 620 975 450 740 1880
* GFR = glomerularfiltrationrate. Cefoxitin sodium must be considered among the drugs of choice in the parenteral treatment of severe urinary tract infection, particularly in cases in which the level of renal function is either depressed or unknown. References Bailey, R. R. & Peddie, B. A. Tobramycin in the treatment of severe and complicated urinary tract infections. New Zealand Medical Journal 84: 1-3 (1976). Bennett, J. V., Brodie, J. L., Benner, E. J. & Kirby, W. M. M. Simplified accurate method for antibiotic assay of clinical specimens. Applied Microbiology 14: 170-7 (1966).
Downloaded from http://jac.oxfordjournals.org/ at University of Bath Library & Learning Centre on July 7, 2015
infection in these patients is that the drug is excreted in adequate concentrations in the urine, even in patients with severe impairment of renal function. Serum levels of cefoxitin in patients with severe renal impairment ranged from 41 to 193 ^g/ml. Urinary levels of cefoxitin ranged from 72 /ig/ml, in a patient with a glomerular filtration rate (GFR) of 4 ml/min, to 1880 ^g/ml in a patient wtih a GFR of 40 ml/min (Table I). This urinary concentration of antibiotic contrasts sharply with the results obtained with aminoglycoside antibiotics (Bailey & Peddie, 1976). Because of the ototoxic hazard of aminoglycoside antibiotics, serum levels of those drugs must be kept below lO^g/ml; in patients with severe impairment of renal function, urinary levels of the antibiotic may not reach even that level.
