Double-Blind Comparison of Cefamandole and Penicillin in Pneumococcal Pneumonia

Abstract

We conducted a prospective, randomized, double-blind comparison of intravenous penicillin and cefamandole in the therapy of pneumococcal pneumonia. Patients received either 1 g of cefamandole or 600,000 U of aqueous penicillin G every 6 h. Of the 100 patients entered into the study, 96 had clinical and radiographic evidence of pneumonia. Microbial etiology was determined from the results of sputum and blood cultures and/or sputum Gram stains. Streptococcus pneumoniae was pathogenic in 49 patients, of whom 24 received cefamandole and 25 received penicillin. There was no statistically significant difference in the response or cure rate. Of the 100 patients, 93 were treated for 3 days or more and were evaluated for adverse effects and toxicity. There was no significant difference between cefamandole-treated and pencillin-treated patients in the incidence of colonization, superinfection, phlebitis, thrombocytosis, decrease in hematocrit, or elevated liver function tests. Eosinophilia occurred more frequently in patients treated with penicillin (20 of 42) than in those treated with cefamandole (11 of 42 (chi square, P < 0.05). Only one patient receiving cefamandole developed a positive direct Coombs test. No patient in either group developed meningitis. We conclude that, with the doses and route of administration employed in this study, cefamandole is as effective as penicillin in the therapy of pneumococcal pneumonia without an increased incidence of colonization, superinfection, or adverse effects.

Ampicillin versus cefamandole as initial therapy for community-acquired pneumonia

“…Side effects and superinfections were infrequent, and their incidence did not differ between the ampicillin and cefamandole groups. Previous antibiotic trials have demonstrated that cefamandole is as efficacious as penicillin for pneumococcal pneumonia (54,55) and as efficacious as ampicillin for lower respiratory infection due to H. influenzae (10). Further, broad-spectrum cephalosporins have not been shown to be more efficacious than cefamandole for communityacquired pneumonia (6,16,20,24,25,31,35,39,58,65).…”

Ceftriaxone (Ro 13-9904) therapy of serious infection

“…Group B streptococci is uniformly susceptible to ceftriaxone (9) Thrombocytosis has been an infrequently recognized condition associated with cephalosporin therapy (10). Four of the patients studied had a marked increase in platelet count within 8 days of starting the antibiotic, and two other patients had a similar but milder increase.…”

“…Although ceftriaxone is a possible cause, it is reasonable to assume that the thrombocytosis observed was in response to severe infection and not the drug. In a double-blinded randomized comparison of cefamandole and penicillin in serious infection, both agents were associated with the same magnitude of thrombocytosis (10).…”

“…It has a potential advantage over other recently discovered P-lactam antibiotics because of a contrast in pharmacokinetics. Ceftriaxone has a serum half-life of 8 h compared with 1 to 3 h for cefotaxime, cefoperazone, moxalactam, and other investigative third-generation cephalosporins (10). This prolonged serum half-life apparently is related to a high degree of protein binding and a different excretion pattern for ceftriaxone compared with the cephalosporins listed above (11,16).…”

Ceforanide and cefazolin therapy of pneumonia: comparative clinical trial

“…This report presents results of a comparative clinical trial to evaluate the safety and efficacy of ceforanide, administered in a dose of 0.5 g every 12 h, compared with cefazolin administered as 1.0 g every 8 h. All patients had community-acquired bacterial pneumonia, with S. pneumoniae, H. influenzae, or both the only pathogens encountered. Blood samples for peak (0.5 to 1.0 h after administration) and trough (0.5 h before the next dose) antibiotic levels after i.m.…”